临床缓解期类风湿关节炎患者外周血Th17检测的意义
Detection significance of Th17 cells in peripheral blood of patients with rheumatoid arthritis in clinical remission
目的 探讨类风湿关节炎(RA)患者外周血Th17表达的水平对早期发现缓解期患者关节侵蚀的意义.方法 选择无关节破坏的活动性RA患者41例,分别在基线及系统治疗24个月时,采用流式细胞术检测外周血Th17表达,同步用ELISA法测定血清白细胞介素(IL)-17A水平,并与患者的病情活动性评价指标(DAS28)进行相关性分析.设30名健康体检者为健康对照组.系统治疗24个月时,将所有患者根据Sharp/van der Heijde评分(SHS)分为关节侵蚀组(P组,10例)(SHS >0.5)和无关节侵蚀组(NP组,26例)(SHS≤0.5),比较两者外周血Th17及IL-17A水平.结果 活动期RA患者的Th17表达明显高于健康对照组[(1.63±0.45)%比(0.91±0.26)%,P<0.01],Th17表达水平与DAS28评分呈正相关(r=0.87,P<0.叭);RA患者IL-17A水平亦明显高于健康对照组[1510±280)ng/L比(320±31) ng/L,P<0.05].进入观察终点的36例患者系统治疗24个月时按DAS28缓解标准均已达到临床缓解(DAS28 <2.6),P组的Th17表达高于NP组,两组的外周血IL-17A水平差异无统计学意义.结论 部分RA患者在达到临床缓解后仍可持续出现结构破坏,外周血Th17高水平对缓解期患者的关节侵蚀有提示意义.
更多Objective To explore the significance and evaluate the early structural erosion through the expressions of Th17 cells in peripheral blood of patients with rheumatoid arthritis (RA) in clinical remission.Methods A total of 41 active RA patients without structural erosion were selected.Intracelluar flow cytometric detection of Th17 cells in peripheral blood was performed.And the supernatant level of interleukin (IL)-17A was determined simultaneously in RA patients and control groups at baseline and endpoint of 24-month therapy.The correlations were analyzed between Th17 cells and RA disease activity index DAS28.They were classified into radiographic progression (P,n =10) and radiographic nonprogression groups (NP,n =26) by the Sharp/van der Heijde score (SHS) at the endpoint.The differences of Th17 cells and IL-17A levels were analyzed between P (SHS > 0.5) and NP groups (SHS ≤ 0.5).Results The expression of Th17 cells in active RA patients was significantly higher than that of controls [(1.63 ± 0.45)% vs (0.91 ± 0.26) %,P < 0.0 1].And the results of IL-17A level were similar [1510 ± 280) vs (320 ±31) ng/L,P<0.05].The expression of Th17 cells was positively correlated with DAS28 score (r =0.87,P < 0.01).Thirty-six RA patients were followed up at the endpoint and all of them stayed in clinical remission (DAS28 < 2.6).The peripheral blood expressions of Th17 cells of P group were significantly higher than those of NP group.At the same time,no differences of IL-17A levels existed between two groups.Conclusion Structural erosion still progresses in some RA patients despite an apparent clinic remission.And a high-level peripheral expression of Th17 hints at structural erosion.
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