CD3^(+)HLA-DR^(+)活化T淋巴细胞对溃疡性结肠炎患者疾病严重程度和药物疗效的预测价值  

The predictive value of CD3^(+)HLA-DR^(+) activated T lymphocytes on the severity and therapeutic efficacy in patients with ulcerative colitis

作　　者：耿白璐 郭静[1] 胡晓飞[1] 刘爱玲[1] 武军[1] 田字彬[1] 丁雪丽[1] GENG Bailu;GUO Jing;HU Xiaofei;LIU Ailing;WU Jun;TIAN Zibin;DING Xueli(Department of Gastroenterology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院消化内科,山东青岛266003

出　　处：《胃肠病学和肝病学杂志》2023年第2期146-150,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：2021年度青岛大学附属医院临床医学+X科研项目(QDFY+X20211036);2021年度青岛市医药卫生科研计划项目(2021-WJZD166)。

摘　　要：目的 探讨外周血CD3^(+)HLA-DR^(+)活化T淋巴细胞(简称活化T细胞)对溃疡性结肠炎(ulcerative colitis, UC)患者疾病严重程度及药物疗效的预测价值。方法 纳入2013年8月至2022年1月就诊于青岛大学附属医院的96例UC患者,根据纳入患者活化T细胞水平分为活化T细胞升高组和活化T细胞正常组,回顾性分析两组患者活化T细胞水平与UC疾病严重程度及药物疗效的相关性及其预测价值。结果 活化T细胞升高组与活化T细胞正常组比较,重度UC患者更多(P<0.001),CRP和ESR水平更高(P<0.05);Spearman相关性分析显示,活化T细胞水平与UC疾病严重程度和CRP水平均呈高度相关(P<0.001)。两组患者药物疗效分析,活化T细胞升高组的维得利珠单抗(Vedolizumab, VDZ)临床缓解率和糖皮质激素有效率更低(P<0.05),两组间英夫利西单抗(Infliximab, IFX)临床缓解率差异无统计学意义(P=0.449)。ROC曲线分析,活化T细胞水平预测UC患者疾病严重程度(AUC=0.854,P<0.001)、VDZ(AUC=0.859,P=0.002)和糖皮质激素(AUC=0.699,P=0.027)疗效的cut-off值分别为5.35%、3.35%、4.55%。结论 外周血CD3^(+)HLA-DR^(+)活化T淋巴细胞水平升高能够初步预测UC疾病重度活动并提示VDZ可能疗效不佳。Objective To investigate the predictive value of CD3^(+)HLA-DR^(+)activated T lymphocytes in peripheral blood on the severity and therapeutic efficacy in patients with ulcerative colitis(UC). Methods A total of 96 UC patients in the Affiliated Hospital of Qingdao University from Aug. 2013 to Jan. 2022 were enrolled. Patients were divided into the increased activated T cells group and the normal activated T cells group according to the activated T cells level. The correlation and predictive value of activated T cells level with the severity and therapeutic efficacy between the two groups were retrospectively analyzed. Results Compared with the normal activated T cells group, severely active patients were significantly more(P<0.001) and the levels of CRP and ESR were significantly higher(P<0.05) in the increased activated T cells group. Spearman correlation showed the activated T cells level was highly correlated with the severity of UC and the level of CRP(P<0.001). The clinical remission rate of Vedolizumab(VDZ) and the effective rate of corticosteroid in the increased activated T cells group were significantly lower than those in the normal activated T cells group(P<0.05) and there was no difference in the clinical remission rate of Infliximab(IFX) between the two groups(P=0.449). ROC curve analysis showed the cut-off values for predicting the severity of UC(AUC=0.854, P<0.001) and therapeutic efficacy of VDZ(AUC=0.859, P=0.002) and corticosteroid(AUC=0.699, P=0.027) were 5.35%, 3.35% and 4.55%, respectively. Conclusion Increased CD3^(+)HLA-DR^(+)activated T lymphocytes level in peripheral blood can preliminarily predict severe activity of UC and suggest the poor therapeutic effects of VDZ.

关 键 词：溃疡性结肠炎 T淋巴细胞 淋巴细胞活化 HLA-DR抗原 

分 类 号：R574.62[医药卫生—消化系统]