类风湿关节炎合并间质性肺疾病患者外周淋巴细胞亚群失衡特点分析  

Characteristics of peripheral lymphocyte subset imbalance in rheumatoid arthritis patients with interstitial lung disease

作　　者：孟利花[1] 谢戬芳[2] 段培青 王泉丽 程超[1] 肖玲[1] MENG Lihua;XIE Jianfang;DUAN Peiqing;WANG Quanli;CHENG Chao;XIAO Ling(Department of Rheumatology,Taiyuan Central Hospital,Taiyuan 030001,China;Department of Rheumatology,Second Hospital of Shanxi Medical University)

机构地区：[1]太原市中心医院风湿免疫科,太原030001 [2]山西医科大学第二医院风湿免疫科

出　　处：《山西医科大学学报》2022年第7期892-897,共6页Journal of Shanxi Medical University

基　　金：山西省重点研发计划项目(201803D31127)。

摘　　要：目的探讨类风湿关节炎(rheumatoid arthritis,RA)合并间质性肺疾病(interstitial lung disease,ILD)患者外周血淋巴细胞亚群水平的变化,评估其与ILD疾病发生的相关性,探索RA-ILD发生发展的免疫细胞相关的危险因素。方法选取2017年1月至2019年9月于山西医科大学第二医院就诊的43例RA合并ILD患者(RA-ILD组)、100例RA不合并ILD患者(RA-non-ILD组)以及57例健康人群(健康对照组)。用改进的流式细胞术检测所有受试者外周血淋巴细胞亚群绝对计数及百分比,采用方差分析或非参数检验比较淋巴细胞水平的组间差异性,并用二元logistics回归分析RA患者合并ILD的危险因素。结果①与RA不合并ILD患者相比,RA-ILD患者病程更长,且外周血血小板计数(PLT)和血小板/淋巴细胞比值(PLR)明显升高(P<0.05)。②RA-ILD患者外周T、B淋巴细胞数目低于健康对照组(healthy controls,HC),而相比于RA不合并ILD患者,RA-ILD患者的T细胞和CD4^(+)T淋巴细胞数目下降(P<0.05)。③RA-ILD患者的Th1、Th17、Treg细胞绝对计数明显低于健康对照,只有Th2细胞计数低于RA不合并ILD患者,差异有统计学意义(P<0.05)。④RA患者合并ILD的危险因素包括RA病程长(OR=1.053,95%CI 1.005~1.103)、CD4^(+)T数目下降(OR=0.998,95%CI 0.997~1.000)、Th2细胞数目下降(OR=0.896,95%CI 0.819~0.981)以及CD4^(+)T细胞百分比的下降(OR=0.957,95%CI 0.922~0.994)(均P<0.05)。结论外周CD4^(+)T细胞淋巴细胞失衡及Th2细胞绝对计数下降是RA患者合并ILD的危险因素,这为评估患者病情、探索新的有效治疗方案提供重要临床依据。Objective To investigate the changes of lymphocyte subsets in peripheral blood of rheumatoid arthritis(RA)patients with interstitial lung disease(ILD)and their correlation with the development of ILD,and to explore the risk factors related to immune cells in the occurrence and development of RA-ILD.Methods A total of 43 RA patients with ILD(RA-ILD group),100 RA patients without ILD(RA-non-ILD group)and 57 healthy subjects(healthy control group)were selected from January 2017 to September 2019 in the Second Hospital of Shanxi Medical University.The absolute count and the percentage of peripheral blood lymphocyte subsets were measured by modified flow cytometry.Analysis of variance and non-parametric test were used to analyze the differences in the levels of lymphocyte subsets among the three groups,and binary logistic regression was used to analyze the risk factors of ILD in RA patients.Results①Compared with RA patients without ILD,RA-ILD patients had longer disease duration and higher levels of platelet(PLT)and platelet/lymphocyte ratio(PLR)(P<0.05).②The numbers of T cells and B cells in RA-ILD patients were lower than those in healthy controls(HC).And the numbers of T cells and CD4^(+)T cells in RA-ILD group were significantly lower than those in RA-non-ILD group(P<0.05).③The absolute counts of Th1 cells,Th17 cells,and Treg cells in RA-ILD patients were significantly lower than those in HC(P<0.05).Compared with RA patients without ILD,only the absolute count of Th2 cells was statistically decreased in patients with RA-ILD(P<0.05).④The longer course of RA(OR=1.053,95%CI 1.005-1.103),decreased Th2 cell counts(OR=0.896,95%CI 0.819-0.981),decreased CD4^(+)T counts(OR=0.998,95%CI 0.997-1.000),and decreased proportion of CD4^(+)T cells(OR=0.957,95%CI 0.922-0.994)were the risk factors for ILD in the patients with RA(P<0.05).Conclusion The imbalance of peripheral CD4^(+)T cell lymphocytes and the decrease of Th2 cell counts are the risk factors for ILD in RA patients,which may provide an important clinical basis

关 键 词：类风湿关节炎 间质性肺疾病 CD4+T细胞 TH2细胞 危险因素 

分 类 号：R593.22[医药卫生—内科学]