类风湿关节炎患者外周血B淋巴细胞及自然杀伤细胞与临床相关性分析

目的探讨类风湿关节炎（RA）患者外周血B淋巴细胞及自然杀伤（NK）细胞的变化情况，了解其变化在类风湿关节炎发病及炎症活动中的意义。方法采用流式细胞仪荧光抗体标记法分别对197例类风湿关节炎患者的外周血淋巴细胞进行CD3／CD8／CD45／CD4及CD3／CD16CD56／CD45／CD19四色荧光抗体（B．D）标记，分析比较类风湿关节炎患者外周血淋巴细胞比例情况，并与类风湿关节炎疾病活动性评分（DAS28）、压痛关节数、肿胀关节数、晨僵时间、医生和患者对疾病活动性的整体评价（VAS）、血红细胞沉降率、C反应蛋白及血清学抗体（AKA，APF，RF，CCP）及是否合并感染等并发症进行相关分析。结果类风湿关节炎组外周血淋巴细胞中CD3-CD19＋细胞和CD3-CD16＋CD56＋细胞占总淋巴细胞数的百分率分别为（12．09±3．47）％和（15．02±2．56）％；类风湿关节炎患者外周血CD3-CD19＋细胞和CD3-CD16＋CD56＋细胞与DAS28呈明显正相关（P〈0．05）；CD3-CD19＋细胞数值与血清抗环瓜氨酸肽抗体水平呈正相关（P〈0．05）；比较出现感染的患者其免疫功能与未发生感染的患者之间CD3-CD19＋细胞数值，CD3-CD16＋CD56＋细胞数值差异有统计学意义（P〈0．05）；比较出现肺间质病变的患者其免疫功能与未发生肺间质病变的患者之间CD3-CD19＋细胞数值差异有统计学意义（P〈0．05）；比较合并干燥综合征的患者CD3-CD19细胞数值、CD3-CD16＋CD56＋细胞数值与未发生干燥综合征的患者差异无统计学意义（P〉0．05）。结论类风湿关节炎患者外周血淋巴细胞存在比例失衡，CD3--CD19＋细胞和CD3-CD16＋CD56＋细胞数量的异常可能是类风湿关节炎发病、炎症活动及合并感染的重要影响因素。

Objective To explore B cells and natural killer(NK)cells changes in pefipheral blood of rheumatoid arthritis(RA)patients to understand the role of the changes in RA patients and inflammation activities of disease.Methods All the RA patients selected into this study were divided into different disease activity group according to Disease Activity Score(DAS28).The peripheral blood mononuclear cells were cultured in vitro.The lymphocytes were marked by four-color fluorescent antibody of CD3/CD4/CD8/CD19 and CD16/CD3/CD19/CD56,and then detected lymphocyte by flow cytometry.We markered and detected the number of the T phenotype cells,B phenotype cells,NK phenotype cells.The correlation between the lymphocyte and diseases activity score,tenderness joint swelling of the joints number,morning stiffness time,doctors and patients to disease activity glogal assessment(VAS),red blood cell subsidence ratio,C.reactive protein and serological antibody was analyzed.Results The proportions of the CD3-CD19+cell and the CD3-CD16+CD56+cell in peripheral iymphocytes was(12.09±3.47)%and(15.02±2.56)%respectively in RA group.Correlation analysis indicated significant negative correlations of the proportions of CD3-CD19+cells with DAS28-4 and a-ccp(P<0.05).Furthermore,CD3+CD19-and CD1-CD19+ cells still showed significant correlation between with pSS and ILD and without(P<0.05).Conclusion There is an imbalance in the proportions of the CD3-CD19+cell and the CD3-CD16+CD56+cell in peripheral iymphocytes with RA.The abnormality of iymphocytes may be a coincidence in the inflammation and infection in patients with RA.