小剂量维A酸对类风湿关节炎患者外周血调节性T细胞的影响及疗效评估  

Effects of low-dose retinoic acid on peripheral blood Treg cells in patients with rheumatoid arthritis and evaluation of efficacy

作　　者：刘小丽[1] 高惠英[1] 张婷婷[1] 尚莉丽 温鸿雁[1] 罗静[1] 李小峰[1] LIU Xiaoli;GAO Huiying;ZHANG Tingting;SHANG Lili;WEN Hongyan;LUO Jing;LI Xiaofeng(The Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院,山西太原030001

出　　处：《临床医药实践》2021年第11期806-810,共5页Proceeding of Clinical Medicine

基　　金：山西省重点研发计划项目(项目编号:201803D31130)。

摘　　要：目的:探索小剂量维A酸对类风湿关节炎(RA)患者外周血CD4^(+)CD25(+)FOXP3(+)调节性T细胞(Treg)绝对数目的影响;同时评估维A酸治疗RA患者的临床疗效。方法:回顾性分析2017年1月-2019年1月主要以维A酸治疗的RA患者34例,依据治疗时间,分为治疗前组、治疗后3个月组、治疗后6个月组和治疗后1年组,选取20例健康者作为健康对照组。比较各组间红细胞沉降率(ESR)、疾病活动度(DAS28)评分、外周血Treg细胞等指标的差异,使用SPSS 22.0软件、采用秩和检验及Kruskal-Wallis检验对数据进行统计分析。结果:与健康对照组相比,治疗前组RA患者外周血Treg细胞的绝对计数明显减低,差异有统计学意义(P=0.002);治疗后各时间段组ESR,DAS28评分较治疗前组下降,差异有统计学意义(P<0.001);治疗后1年组Treg细胞绝对计数比治疗后3个月组及6个月组均有不同程度升高,但仍比健康对照组低。结论:RA患者外周血Treg细胞水平明显降低,这可能是RA患者疾病发生的主要原因之一,加用小剂量维A酸治疗可增加RA患者外周血Treg细胞水平,且具有时间依赖性,并同时可降低RA患者ESR及DAS28评分,即能有效降低RA患者疾病活动度,改善病情。Objective:To investigate the effects of low dose retinoic acid on the absolute number of CD4^(+)CD25(+)FOXP3(+) regulatory T cells(Treg)in peripheral blood of patients with rheumatoid arthritis(RA).The clinical efficacy of retinoic acid in RA patients was also evaluated.Methods:The clinical data of 34 RA patients who were treated with retinoic acid from January 2017 to January 2019 were retrospectively analyzed.According to the treatment time,they were divided into the pre-treatment group(without retinoic acid),3 months after treatment,6 months after treatment and 1 year after treatment.Twenty patients were selected as healthy control group.Clinical data were collected and compared to compare the differences in erythrocyte sedimentation rate(ESR),disease activity(DAS28 score),peripheral blood Treg cells and other indicators among the groups.SPSS 22.0 software,rank sum test and Kruskal-Wallis test were used to statistically analyze the data.Results:Compared with the healthy control group,the absolute count of Treg cells in peripheral blood of RA patients in the pre-treatment group was significantly decreased,and the difference was statistically significant(P=0.002).ESR and DAS28 scores in each time after treatment decreased compared with those before treatment,and the difference was statistically significant(P<0.001).After 1 year of treatment,compared with 3 months and 6 months after treatment,the group had different degrees of increase,but still reduced compared with the healthy control group.Conclusion:RA patients with peripheral blood Treg cells were obviously reduced,this may be one of the leading causes of disease,RA patients combined with small dose of vitamin A acid treatment can increase the RA patients with peripheral blood levels of Treg cells,and has time dependence,and at the same time can reduce the ESR RA patients and DAS28 score,which can effectively reduce the disease activity in patients with RA,improve the condition.

关 键 词：类风湿关节炎 调节性T细胞 维A酸 治疗 疾病活动度 

分 类 号：R593.2[医药卫生—内科学]