幼年特发性关节炎患儿外周血自然杀伤细胞CD^(16+56+)的随访意义

Change of natural killer cells CD^(16+56+) in children with systemic onset juvenile idiopathic arthritis

目的:探讨幼年特发性关节炎全身型(systemic onset juvenile idiopathic arthritis,SOJIA)患儿治疗过程自然杀伤细胞(natural killer cells,NKcells)CD16+56+比率、骨髓细胞形态学等指标的动态变化在提示病情发展、改善预后方面的意义。方法:对我院2006年6月至2008年6月收治的30例SOJIA病例,分析治疗早期及联合治疗后多项炎症指标、外周血NK cells CD16+56+比率、骨髓细胞形态学动态变化与临床表现之间的关系。结果:所有患儿中10例病情反复难治者,均出现非特异性炎症指标升高,9例外周血NK cells CD16+56+比率降低,8例骨髓细胞形态学发生变化(4例发现异形淋巴细胞,4例有吞噬现象)。及时采用强联合治疗方案后,8例病情得到控制,2例进展为巨噬细胞活化综合征。结论:SOJIA临床表现多样,实验室指标非特异性指向,治疗中同时警惕NK cells CD16+56+比率和骨髓细胞形态学等变化,及早采用个体化强联合治疗方案,是阻止病情发展,改善预后的关键。

Objective To investigate the changes of expression rate of natural killer （NK） cells CD^16＋56＋and bone marrow cellular morphologie parameters during the treating course in children with systemic onset juvenile idiopathic arthritis （SOJIA）. Methods The correlations between the changes of inflammatory parameters, expression rate of NK cells CD^16＋56＋, or bone marrow cellular morphologic parameters and clinical manifestation were analyzed in 30 children with SOJIA from Jun 2006 to Jun 2008. Results Non-inflammatory parameters were increased in 10 cases who were resistant to treatment. Out of them, the expression rate of NK cells CD^16＋56＋ was decreased in 9 eases, bone marrow cellular morphologie changes were observed in 8 cases, which included dismorphic lymphoeytes （n = 4） and definite endoeytosis （n = 4）. 8 cases were effectively controlled and 2 cases developed to macrophage activation syndrome after aggressive therapy. Conclusion The changes of expression rate of NK cells CD^16＋56＋ and bone marrow cellular morphologic parameters are valuable indicators for the prognosis of SOJIA.