抗合成酶综合征重叠类风湿关节炎患者的免疫学特征  

Immunological characteristics of patients with anti-synthetase syndrome overlap with rheumatoid arthritis

作　　者：赵亮 史成龙 马柯 赵静[1] 王潇 邢晓燕 莫万星 练益瑞 高超[1] 李玉慧[1,3] ZHAO Liang;SHI Chenglong;MA Ke;ZHAO Jing;WANG Xiao;XING Xiaoyan;MO Wanxing;LIAN Yirui;GAO Chao;LI Yuhui(Department of Rheumatology and Immunology,Peking University People’s Hospital,Beijing 100044,China;Department of Gastrointestinal Oncology,Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Rheumatology and Immunology,Peking University People’s Hospital,Qingdao,Qingdao 266111,Shandong,China;Department of Hematology and Rheumatology,the People’s Hospital of Xishuangbanna Dai Nationality Autonomous Prefecture,Xishuangbanna 666100,Yunnan,China)

机构地区：[1]北京大学人民医院风湿免疫科,北京100044 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所消化肿瘤内科,北京100142 [3]北京大学人民医院青岛医院风湿免疫科,山东青岛266111 [4]西双版纳傣族自治州人民医院血液风湿免疫科,云南西双版纳666100

出　　处：《北京大学学报（医学版）》2024年第6期972-979,共8页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(82371804);北京市自然科学基金(L222017);北京大学人民医院研究与发展基金(RDX2023-03、RZ2024-02)。

摘　　要：目的:探究抗合成酶综合征(anti-synthetase syndrome,ASS)重叠类风湿关节炎(rheumatoid arthritis,RA)患者的免疫学特点。方法:回顾性分析北京大学人民医院住院的104例ASS伴有关节炎患者的资料,包括人口学资料、临床表现(皮疹、肌肉损害等)、实验室检查结果、外周血淋巴细胞亚群和治疗用药,依据患者是否重叠RA进行分组并比较。结果:104例ASS伴有关节炎的患者中,明确诊断RA的患者占23.1%(24/104例),ASS重叠RA组患者的快速进展型间质性肺炎(rapid progressive interstitial lung disease,RP-ILD)发生率(41.7%vs.17.6%,P=0.032)、压痛关节数[10(7,14)个vs.4(0,8)个,P<0.001]、肿胀关节数[4(2,8)个vs.2(0,4)个,P=0.012]及骨侵蚀发生率(47.8%vs.2.5%,P<0.001)均显著高于非RA组。实验室检查方面,血小板水平[(289.57±68.74)×10^(3)/μL vs.(247.94±77.04)×10^(3)/μL,P=0.022]、红细胞沉降率[43(19,59)mm/h vs.18(10,44)mm/h,P=0.019]和C反应蛋白[19.20(4.80,55.36)mg/L vs.5.68(1.10,14.96)mg/L,P=0.006]在ASS重叠RA组的患者中显著升高。免疫学指标检查显示,与ASS合并关节炎的患者组相比,ASS重叠RA组患者的外周血CLA^(+)Treg细胞[(11.12±4.10)%vs.(17.22±8.49)%,P=0.003]、B细胞[8.56%(4.80%,11.90%)vs.14.55%(8.75%,20.29%),P=0.025]、自然杀伤(natural killer,NK)细胞[7.56%(4.65%,13.20%)vs.13.25%(7.46%,19.25%),P=0.045]的比例显著降低,Na6ve Th细胞[(52.66±17.66)%vs.(40.76±14.96)%,P=0.033]的比例显著升高。治疗反应方面,ASS重叠RA组患者的完全临床应答率较低(16.7%vs.43.8%,P=0.031)。结论:ASS重叠RA患者的肺部及关节受累更严重,治疗应答率低,对此类患者需早期识别并积极干预。Objective:To investigate the clinical and immunological characteristics of anti-synthetase syndrome(ASS)patients overlap with rheumatoid arthritis(RA).Methods:A retrospective analysis was conducted on ASS patients with arthritis who were treated at Peking University People’s Hospital.Data collected included demographic information,clinical manifestations,laboratory features,lymphocyte subsets in peripheral blood,and treatments.The patients with ASS were divided into two groups based on the presence or absence of RA for comparative analysis.Results:A total of 104 ASS patients with arthritis were included,among whom^(2)3.1%(24/104)were diagnosed with RA.The ASS with RA group had a significantly higher incidence of rapidly progressive interstitial lung disease(RP-ILD)(41.7%vs.17.6%,P=0.032),number of tender joints[10(7,14)vs.4(0,8),P<0.001],number of swollen joints[4(2,8)vs.2(0,4),P=0.012],and rate of bone erosion(47.8%vs.2.5%,P<0.001)compared with the non-RA group.Levels of platelets[(289.57±68.74)×10^(3)/μL vs.(247.94±77.04)×10^(3)/μL,P=0.022],erythrocyte sedimentation rate(ESR)[43(19,59)mm/h vs.18(10,44)mm/h,P=0.019],and C-reactive protein(CRP)[19.20(4.80,55.36)mg/L vs.5.68(1.10,14.96)mg/L,P=0.006]were found significantly higher in the ASS with RA group than those in non-RA group.Analysis of immune cells in peripheral blood mononuclear cell(PBMC)showed that significantly decreased proportions of CLA^(+)Treg cells[(11.12±4.10)%vs.(17.22±8.49)%,P=0.003],B cells[8.56%(4.80%,11.90%)vs.14.55%(8.75%,20.29%),P=0.025],and natural killer(NK)cells[7.56%(4.65%,13.20%)vs.13.25%(7.46%,19.25%),P=0.045]in the overlap group compared with non-RA group.Proportion of Na ve Th cells[(52.66±17.66)%vs.(40.76±14.96)%,P=0.033)]was significantly increased in overlap group compared with non-RA group.Overlap group had lower rate of complete clinical response than non-RA group(16.7%vs.43.8%,P=0.031).Conclusion:Among ASS patients with arthritis,those with RA have more severe lung and joint involvement and a lower treatment respon

关 键 词：抗合成酶综合征 类风湿关节炎 淋巴细胞亚群 完全临床应答 

分 类 号：R593.2[医药卫生—内科学]