类风湿关节炎不同滑膜淋巴细胞分布类型的临床病理特点

Pathological and Clinical Features of Different Synovial Lymphatic Organization in Rheumatoid Arthritis

【目的】探讨类风湿关节炎(RA)滑膜淋巴细胞分布与滑膜病理改变及临床病情活动性的关系。【方法】细针滑膜活检获取48例活动期RA滑膜,连续切片HE及免疫组化染色观察淋巴细胞分布及病理改变,同时记录临床资料,对照组为骨关节炎14例和非炎性关节病16例。【结果】①48例RA滑膜根据衬里下层淋巴细胞分布特征分为生发中心(GC)型9例(18.8%)、聚集(Agg)型16例(33.3%)、弥漫型(Dif)型15例(31.2%)及无明显淋巴细胞浸润(Non)型8例(16.7%);②RA滑膜病理滑膜炎积分、衬里下层炎症细胞总数及B淋巴细胞数依次为GC型>Agg型>Dif型>Non型,均有统计学差异(P<0.05);③GC型、Agg型、Dif型患者关节压痛数及肿胀数均明显高于Non型(P<0.05),且GC型、Agg型患者的CRP、ESR、TNFα水平及DAS28高于Dif型、Non型(P<0.05);④随访3个月后,Non型患者病情缓解率为87.5%(7/8),而GC型仅为11.1%(1/9)(P<0.05)。【结论】滑膜淋巴细胞分布类型能较好地反映RA滑膜炎症状况及临床病情活动性,并有助于预测病情缓解,有望成为一种新的RA病情评估及预后判断的客观指标。

【Objective】 To investigate the pathological and clinical features of different synovial lymphatic organization in rheumatoid arthritis （RA）. 【Methods】 The synovium of 48 patients with RA was acquired by needle synovial biopsy, and clinical data was collected simultaneously. The synovial lymphatic organization was analyzed by sequential sections with HE and immunohistochemical staining. Synovium of 14 patients with osteoarthritis and 16 patients of orthopedic arthropathies was taken as control. 【Results】 ① The subsets of synovial lymphatic organization included 18.8% （9 / 48） germinal center （GC） synovitis, 33.3% （16 / 48） aggregate （Agg） synovitis, 31.2% （15 / 48） diffuse （Dif） synovitis and 16.7% （8 / 48） had no lymphocyte infiltrating （Non）; ② Pathological analysis showed significant difference in synovitis scores, amount of inflammatory cells as well as B lymphocytes in sublining area among four subsets, GC〉 Agg〉 Dif〉 Non in turn （P〈0.05）; ③ Clinical analysis showed tender joint count and swelling joint count in the patients with GC, Agg, Dif subsets were higher significantly than those with Non subset; DAS28, ESR, CRP, and TNFα elevated significantly in the patients with GC and Agg subsets than those with Dif and Non subsets （P〈0.05）; ④ Remission rate after 3 months was 87.5% （7 / 8） in patients with Non subset, 11.1% （1 / 9） in patients with GC subset （P〈0.05）. 【Conclusions】 Synovial lymphatic organization can well reflect synovitis degree, disease activity and prognosis which may become a new objective evaluating indicator for clinic.