类风湿关节炎合并心血管疾病患者外周血调节性T细胞水平变化及临床意义  

Change of peripheral blood regulatory T cells level and its clinical significance in rheumatoid arthritis patients with cardiovascular disease

作　　者：郝莉敏[1] 薛丽巾[1] 张婷婷[1] 赵向聪[1] 罗静[1] 王彩虹[1] 牛红青[1] Hao Limin;Xue Lijin;Zhang Tingting;Zhao Xiangcong;Luo Jing;Wang Caihong;Niu Hongqing(Department of Rheumatology and Immunology,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风湿免疫科,太原030001

出　　处：《中华风湿病学杂志》2022年第8期505-511,共7页Chinese Journal of Rheumatology

基　　金：山西省自然科学基金面上项目(20210302123274);山西医科大学第二医院院科研基金(202001-3)。

摘　　要：目的分析RA合并心血管疾病(CVD)患者外周血调节性T细胞(Treg)水平及其临床意义。方法收集2019年1月至2021年1月于山西医科大学第二医院风湿免疫科就诊的191例RA患者的临床资料,根据有无合并CVD,分为单纯RA组(120例)和RA-CVD组(71例)。并收集同期我院健康体检人员86名作为健康对照。采集所有患者和健康对照者外周血,流式细胞术检测CD4+T细胞亚群。采用SPSS 25.0软件进行独立样本t检验、Mann-WhitneyU检验或χ^(2)检验比较组间差异,二元Logistic回归分析RA合并CVD的危险因素。结果①RA-CVD组患者年龄及男性患者比例显著高于单纯RA组[年龄分别为(64±10)岁和(56±12)岁,t=-4.16,P<0.001;男性患者分别为35例和31例,χ^(2)=10.86,P=0.001]。②与健康对照组相比,单纯RA组和RA-CVD组患者外周血Treg细胞数均明显降低(Z=-4.14,P<0.001;Z=-6.27,P<0.001),Th17细胞绝对计数差异均无统计学意义(P>0.05),Th17/Treg细胞比值均有增高趋势,但仅RA-CVD组差异有统计学意义(Z=-5.49,P<0.001)。③与单纯RA组比较,RA-CVD组患者外周血Treg细胞绝对计数显著降低[19.00(13.62,26.73)和24.94(19.32,34.12),Z=-3.19,P=0.001],Th17细胞数量显著升高[绝对计数:7.77(3.86,13.64)个/μl和5.59(3.49,8.91)个/μl,Z=-2.14,P=0.033;比率:1.37%(0.78,2.00)%和0.80%(0.56,1.24)%,Z=-4.20,P<0.001],且Th17/Treg细胞比值显著升高[0.40(0.24,0.62)和0.23(0.14,0.35),Z=-4.46,P<0.001]。④Logistic回归分析表明,Treg细胞绝对计数[OR(95%CI)=0.934(0.903,0.967)]是CVD的保护因素,而高龄[OR(95%CI)=1.038(1.003,1.074)]、男性[OR(95%CI)=2.450(1.005,5.973)]、高血压[OR(95%CI)=2.654(1.219,5.779)]、Th17细胞绝对计数[OR(95%CI)=1.066(1.019,1.116)]是CVD的危险因素。结论RA合并CVD患者外周血Treg细胞数量显著减低,且Th17/Treg免疫失衡较未合并CVD的RA患者更明显,提示Treg细胞数量和(或)功能缺陷导致的免疫失衡和功能紊乱可能参与了RA并发CVD的发生发展过程。Objective To investigate the level of peripheral blood regulatory T cells in rheumatoid arthritis(RA)patients with cardiovascular disease(CVD)and its clinical significance.Methods A total of 191 patients with RA in the Department of Rheumatology and Immunology,the Second Affiliated Hospital of Shanxi Medical University and 86 healthy controls(HCs)were enrolled from January 2019 to January 2021.All peripheral blood CD4+T lymphocyte subsets of participants were assessed by flow cytometry.Patients were divided into RA-CVD group(n=71)and RA only group(n=120)and their clinical data were recorded.The differences between the groups were analyzed by Independent-Samples t test,Mann-Whitney U test orχ^(2) test,and risk factors that affected CVD were analyzed using Logistic regression.Results①The age of patients and the proportion of male patients in the RA-CVD group were significantly higher than those in the RA only group[age:(64±10)years old vs(56±12)years old,t=-4.16,P<0.001;male patients:35 cases vs 31 cases,χ^(2)=10.86,P=0.001].②The level of Treg cells in the peripheral blood of patients with RA only and RA-CVD groups was significantly lower than that of HCs(Z=-4.14,P<0.001;Z=-6.27,P<0.001),while the numbers of peripheral Th17 cells in the two groups of patients were not significantly different from those of HCs(P>0.05).The ratios of Th17/Treg cells in the two group patients were higher than those of HCs,but only the difference between RA-CVD patients and HCs was significant(Z=-5.49,P<0.001).③Compared with the RA only group,the absolute number of Treg cells in peripheral blood of RA-CVD group was significantly lower[19.00(13.62,26.73)vs 24.94(19.32,34.12),Z=-3.19,P=0.001],the level of Th17 cells was significantly higher[absolute number:7.77(3.86,13.64)cell/μl vs 5.59(3.49,8.91)cells/μl,Z=-2.14,P=0.033;percentage:1.37%(0.78,2.00)%vs 0.80%(0.56,1.24)%,Z=-4.20,P<0.001],and the ratio of Th17/Treg cells was significantly higher[0.40(0.24,0.62)vs 0.23(0.14,0.35),Z=-4.46,P<0.001].④Logistic regression analysis s

关 键 词：关节炎 类风湿 心血管疾病 T淋巴细胞 调节性 

分 类 号：R593.22[医药卫生—内科学] R54[医药卫生—临床医学]