强直性脊柱炎患者Th淋巴细胞功能的研究

The Function of Helper T Lymphocytes in Ankylosing Spondylitis

目的:探讨辅助性T细胞(Th)Th1/Th2比例失衡及Th1/Th2细胞因子网络的异常在强直性脊柱炎(AS)发病机制中的作用。方法:利用酶联免疫吸附试验(ELISA)测定30例AS伴膝关节积液患者、20例正常对照血清及AS患者关节液中Th1/Th2型细胞因子肿瘤坏死因子-α(TNF-α)和白细胞介素(IL)-10;应用三色流式细胞分析法(FCM)检测外周血Th细胞(CD3+CD4+)比例及其胞浆内Th1/Th2细胞因子干扰素-γ(IFN-γ)和IL-4的表达;AS患者同时检测红细胞沉降率(ESR)及C-反应蛋白(CRP)。结果:(1)AS患者血清TNF-α和IL-10水平均明显高于正常对照组(P<0.01),AS患者关节液TNF-α水平高于血清水平(P<0.01),IL-10水平与血清中水平差异无统计学意义(P>0.05)。(2)AS患者外周血Th、Th2细胞(CD3+CD4+IL-4+)百分率与对照组差异无统计学意义(P>0.05),而Th1细胞(CD3+CD4+IFN-γ+)百分率及Th1/Th2比值高于对照组(P<0.01)。(3)AS患者血清中TNF-α的水平与ESR、CRP呈正相关(P<0.01或P<0.05);而IL-10水平、外周血Th1和Th2细胞百分率、Th1/Th2比值与ESR、CRP均无明显相关性(P>0.05)。结论:AS患者外周血存在Th1/Th2比例失衡,为Th1优势状态。Th1型细胞因子TNF-α在AS患者外周血及关节液中均呈现高水平表达。

Objective：To study the role of the imbalance of helper T（Th） 1/Th2 and Th1/Th2 cytokines in the pathogenesis of ankylosing spondylitis（AS）.Methods：Thirty patients with AS and 20 normal controls were included in this study.Enzyme linked immunosorbent assay（ELISA） was used to measure the levels of tumor necrosis factor（TNF）-α and interleukin（IL）-10 in the serum and synovial fluid.The expressions of surface antigens（CD3,CD4） of Th cells and intracellular cytokines（IFN-γ/IL-4） of Th1/Th2 in the peripheral blood were detected by three-color flow cytometric analysis in patients with AS and normal controls.The levels of erythrocyte sedimentation rate（ESR） and C reactive protein（CRP） were detected in patients of AS.Results：The serum levels of TNF-α and IL-10 were significantly higher in patients with AS than those in normal controls（P 0.01）.The synovial fluid level of TNF-α was significantly higher than that of serum level（P 0.01）.There was no significant difference in the level of IL-10 between synovial fluid and the serum（P 0.05）.The percentage of Th and Th2 cells in the peripheral blood was not significantly different in patients with AS than that of normal controls（P 0.05）.But the percentage of Th1 cells in the peripheral blood was significantly higher in patients of AS than that of normal controls（P 0.01）.The serum level of TNF-α was significantly correlated with ESR and CRP（P 0.01 and P 0.05）.There was no significant correlation between the serum level of IL-10,the percentage of Th1 cells（or Th2 cells）,the rate of Th1/Th2,ESR and CRP（P 0.05）.Conclusion：There is an imbalance in Th1/Th2 in the peripheral blood of patients with AS,and towards Th1.There was a high level expression of TNF-α in the peripheral blood and the synovial fluid