临床缓解期类风湿关节炎患者外周血Th17检测的意义

Detection significance of Th17 cells in peripheral blood of patients with rheumatoid arthritis inclinical remission

目的探讨类风湿关节炎（RA）患者外周血Thl7表达的水平对早期发现缓解期患者关节侵蚀的意义。方法选择无关节破坏的活动性RA患者41例，分别在基线及系统治疗24个月时，采用流式细胞术检测外周血Thl7表达，同步用ELISA法测定血清白细胞介素（IL）．17A水平，并与患者的病情活动性评价指标（DAS28）进行相关性分析。设30名健康体检者为健康对照组。系统治疗24个月时，将所有患者根据Sharp／vanderHeijde评分（SHS）分为关节侵蚀组（P组，10例）（SHS〉0．5）和无关节侵蚀组（NP组，26例）（SHS≤0．5），比较两者外周血Thl7及IL-17A水平。结果活动期RA患者的Thl7表达明显高于健康对照组[（1．63±0．45）％比（0．91±0．26）％，P〈0．01]，Th17表达水平与DAS28评分呈正相关（r=0．87，P〈0．01）；RA患者IL-17A水平亦明显高于健康对照组[15104-280）ng／L比（320±31）ng／L，P〈0．05]。进入观察终点的36例患者系统治疗24个月时按DAS28缓解标准均已达到临床缓解（DAS28〈2．6），P组的Th17表达高于NP组，两组的外周血IL-17A水平差异无统计学意义。结论部分RA患者在达到临床缓解后仍可持续出现结构破坏，外周血Th17高水平对缓解期患者的关节侵蚀有提示意义。

Objective To explore the significance and evaluate the early structural erosion through the expressions of Thl7 cells in peripheral blood of patients with rheumatoid arthritis （ RA ） in clinical remission. Methods A total of 41 active RA patients without structural erosion were selected. Intracelluar flow cytometric detection of Thl7 cells in peripheral blood was performed. And the supernatant level of interleukin （IL）-17A was determined simultaneously in RA patients and control groups at baseline and endpoint of 24-month therapy. The correlations were analyzed between Th17 cells and RA disease activity index DAS28. They were classified into radiographic progression （P, n = 10 ） and radiographic non- progression groups （NP, n = 26 ） by the Sharp/van der Heijde score （SHS） at the endpoint. The differences of Thl7 cells and IL-17A levels were analyzed between P （ SHS 〉 0. 5 ） and NP groups （ SHS≤0. 5 ）. Results The expression of Thl7 cells in active RA patients was significantly higher than that of controls [ （ 1.63±0. 45） % vs （0. 91±0. 26） %, P 〈0. 01 ]. And the results of IL-17A level were similar [ 1510 ±280） vs （320 ± 31 ） ng/L, P 〈 0. 05 ]. The expression of Thl7 cells was positively correlated with DAS28 score （ r = 0. 87, P 〈 0. 01 ）. Thirty-six RA patients were followed up at the endpoint and all of them stayed in clinical remission （ DAS28 〈 2.6 ） . The peripheral blood expressions of Thl7 cells of P group were significantly higher than those of NP group . At the same time, no differences of IL-17A levels existed between two groups. Conclusion Structural erosion still progresses in some RA patients despite an apparent clinic remission. And a high-level peripheral expression of Thl7 hints at structural erosion.