摘要目的 分析幼年特发性关节炎(JIA)及其不同亚型的细胞及体液免疫特征,探讨细胞免疫及体液免疫功能在JIA发病机制中的作用及临床应用价值.方法 应用流式细胞仪免疫荧光法检测92例JIA患儿和82例健康对照儿童的T淋巴细胞亚群、自然杀伤(NK)细胞、B淋巴细胞变化,酶联免疫吸附试验(ELISA)法检测血清白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)、IL-10、转化生长因子-β(TGF-β)水平,速率散射比浊法检测免疫球蛋白IgG、IgM、IgA及补体C3、C4水平.采用独立样本t检验、One-Way ANOVA和Pearson检验行数据分析.结果 1.与对照组相比,JIA组CD3、CD4、IL-1、TNF-α、IgG、IgM、IgA、C3水平均升高(P均＜0.05),CD4CD25、CD8、NK细胞、IL-10、TGF-β水平均降低(P均＜0.05),CD4/CD8比值升高(P＜0.05).2.全身型JIACD4水平、CD4/CD8比值、IL-1、TGF-β、IgG、IgM、IgA、C3、C4水平高于少关节型(P均＜0.05),CD4CD25、CD8、IL-10水平低于少关节型(D均＜0.05),多关节型IL-1、TNF-α、IgG、IgM、IgA水平高于少关节型(P均＜0.05),CD4CD25、CD8、IL-10水平低于少关节型(P均＜0.05),全身型CD4、TGF-β、C3、C4水平高于多关节型(P均＜0.05).3.JIA组IL-1、TNF-α与C反应蛋白(CRP)、红细胞沉降率(ESR)呈正相关(P均＜0.05),IL-10、TGF-β与CRP、ESR呈负相关(P均＜0.05).结论 JIA存在细胞及体液免疫功能的紊乱,参与了JIA的发病机制,表现为T辅助细胞功能活化,Th1类细胞因子增加,抑制性T淋巴细胞及调节性T淋巴细胞功能减低,抑制性细胞因子降低,免疫球蛋白水平增加,介导了JIA的自身炎性反应及关节骨质的破坏,其中全身型和多关节型免疫紊乱更为显著;IL-1、TNF-α、IL-10、TGF-β与病情活动度相关.

abstractsObjective To analyze the changes of celluar and humoral immunity in children with juvenile idiopathic arthritis(JIA),as well as the changes in different subtypes,and to investigate the role of cellular and humoral immunity in the pathogenesis of JIA.Methods Ninety-two JIA subjects and 82 controls(healthy children) were included into this study.The levels of T lymphocyte subsets,natural killer (NK)cells,and B cells were analyzed by using flow cytometry.The serum interleukin-1 (IL-1),tumor necrosis factor-α (TNF-α),interleukin-l0 (IL-10),transforming growth factor-β(TGF-β) levels were detected by using enzyme-linked imnmunosorbent assay (ELISA).The serum IgG,IgM,IgA and C3,C4 levels were detected by using velocity scatter turbidimetry.Independent t-test,One-Way ANOVA test and Pearson analysis were adopted for data analysis.Results 1.In the group of JIA,the levels of CD3,CD4,IL-1,TNF-α,IgG,IgM,IgA and C3 were higher than those in the control group(all P ＜ 0.05),while the levels of CD4CD25,CD8,NK cells,IL-10 and TGF-β were lower than those in the control group(all P ＜0.05),and the ratio of CD4/CD8 was higher than that in the control group (P ＜ 0.05).2.In the group of systemic-onset JIA (so-JIA),the levels of CD4,IL-1,TGF-β,IgG,IgM,IgA,C3 and the ratio of CD4/CD8 were higher than those in the oligoarthritis JIA group(all P ＜ 0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group(all P ＜ 0.05).In the group of polyarthritis JIA,the levels of IL-1,TNF-α,IgG,IgM and IgA were higher than those in the oligoarthritis JIA group(all P ＜0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group (all P ＜ 0.05) ; In the group of so-JIA,the levels of CD4,TGF-β,C3 and C4 were higher than those in the polyarthritis JIA group (all P ＜ 0.05).3.The value of IL-1,TNF-α were positively correlated with that of C-reactive protein (CRP),erythrocyte sedimentation rate(ESR) in the JIA group(all P ＜ 0.05),while the value of IL-10,TGF-β was negatively correlated with that of CRP,ESR(all P ＜ 0.05).Conclusions There are cellular immunity and humoral immunity disorders in the JIA.Cellular immunity and humoral immunity are all involved in the pathogenesis of JIA.T helper cells are activated and Th1 cytokines increase,suppressive T cells,regulatory T cells impairment and suppressive cytokines decrease but immunoglobin increase,which involve in auto inflammation reaction and articular destruction in JIA.The immunity disturbances are more striking in so-JIA and polyarthritis JIA.IL-1,TNF-α,IL-10 and TGF-β are correlated with the disease activity.