天疱疮和大疱性类天疱疮患者外周血滤泡辅助性T细胞水平的研究

Follicular helper T cells in peripheral blood of patients with pemphigus and bullous pemphigoid

目的探讨滤泡辅助性T细胞（Tfh）在天疱疮和大疱性类天疱疮发病中的作用。方法天疱疮和大疱性类天疱疮患者各10例，与天疱疮和大疱性类天疱疮患者年龄、性别相匹配的正常人对照各10例。采用流式细胞仪检测外周血单一核细胞（PBMc）中Tih水平，采用酶联免疫吸附法（ELISA）检测其血清中白介素21（IL-21）水平，同时检测大疱性类天疱疮患者血清中抗BPl80一NCl6A抗体滴度，并进行抗体滴度与IL-21、Tfh水平的相关性分析。结果天疱疮患者组血清中IL-21水平（95．33±33．69ng／L）显著高于其正常人对照组（54．50±18．13ng／L）（t=3．38，P〈0．01），Tnl水平（12．08％±4．74％）亦显著高于其正常人对照组（6．15％±1．62％）（t=3．74，P〈0．01）。大疱性类天疱疮患者组血清中IL-21水平（106．70±44．91ng/L）显著高于其正常人对照组（55．37±15．89ng／L）（t=3．41，P〈0．01），Tfh水平（11．85％±3．14％）亦显著高于其正常人对照组（6．03％±1．74％）（t=5．13，P〈0．01）。大疱性类天疱疮组抗BPl80-NCl6A抗体滴度与IL-2l水平呈正相关（r=0．77，P〈0．01），与Tfh水平亦呈正相关（r=0．67，P〈0．05）。结论天疱疮和大疱性类天疱疮患者，IIm及其分泌的细胞因子IL-21水平均明显升高，可能在其发病过程中起一定的作用。

Objective To explore the roles of follicular helper T cells （Tfh） in the pathogenesis of pemphigus and bullous pemphigoid （BP）. Methods Venous blood was collected from 20 patients （including 10 cases of pemphigus and 10 cases of BP） and 20 age- and sex-matched normal human controls. Enzyme linked immunosorbent assay （ELISA） was performed to measure the levels of serum interleukin （IL）-21 and anti-BP180- NC16A antibody, and flow cytometry to detect the percentage of Tfh in peripheral blood mononuclear cells （PBMCs）. The relationship of anti-BP180-NC16A antibody titer to Tfh and IL-21 levels was assessed by linear correlation analysis. Results The serum IL-21 level and Tfh percentage in PBMCs were significantly higher in patients with pemphigus than in the normal controls （95.33 ± 33.69 vs. 54.50 ±18.13 pg/ml, t = 3.38, P〈 0.01; 12.08% ± 4.74% vs. 6.15% ± 1.62%, t = 3.74, P 〈 0.01 ）, and higher in patients with BP than in the normal controls （106.70 ＋ 44.91 vs. 55.37 ± 15.89 pg/ml, t = 3.41, P〈 0.01; 11.85% ±3.14% vs. 6.03% ± 1.74%, t = 5.13, P 〈 0.01 ）. The titer of anti-BP180-NC 16A antibody was positively correlated with the percentage of Tfh （r = 0.67, P〈 0.05） and serum level of IL-21 （r= 0.77, P〈 0.01） in patients with BP. Conclusions There is a significant increase in the percentage of Tfh and serum level of IL-21 in patients with pemphigus and BP, hinting a certain role of Tfh and IL-21 in the pathogenesis of pemphigus and BP.