破骨细胞和RANKL在幼年特发性关节炎中的作用机制

The mechanism of actions of osteoclasts and RANKL in juvenile idiopathic arthritis

目的探讨不同时期幼年特发性关节炎(JIA)患儿血清中RANKL和破骨细胞的水平变化,并进一步研究其临床意义。方法研究分为初发活动期、疾病缓解期和正常健康儿童3组,每组20例。采用ELISA方法检测血清中RANKL的表达水平,细胞爬片法检测患儿血液中破骨细胞的数量,统计学分析处理数据。结果 RANKL和OPG在初发活动期组(423.12±62.19)pg/ml、(510.72±58.07)pg/ml和疾病缓解期组(434.26±78.68)pg/ml患儿血清中的表达均高于正常健康对照组(360.47±48.60)pg/ml,差异有统计学意义(均P<0.05);破骨细胞在JIA初发活动期患儿体内的表达水平高于健康对照组儿童体内表达水平,差异有统计学意义(P<0.05),而疾病缓解期组患儿体内破骨细胞表达水平略高于健康对照组儿童,差异无统计学意义(P>0.05)。OPG表达水平与DAS28负相关(P<0.05);而RANKL/OPG抗CCP抗体正相关(P<0.05)。结论 RANKL在初发活动期组JIA患儿血清中表达显著升高,与之相应的,破骨细胞子在JIA初发活动期患儿体内水平也显著上升,提示RANKL可能促进破骨细胞的分化和成熟。

Objective To investigate the levels of RANKL and osteoclast in juvenile idiopathic arthritis （JIA） at different periods,and study its clinical significance. Methods The study was divided into 3 groups ：primary active JIA group,remission JIA group and normal healthy children group,20 cases in each group. Using ELISA method to detect the expression of RANKL in serum, the number of osteoclast cells were counted using cell climbing piece assay. Data was analyzed and processed. Results The RANKL expression in the primary active JIA group （510.72＋58.07）pg/ml and remission JIA group （434.26＋78.68） were higher than that in normal healthy control group（360.47 ＋48.60）pg/ml, and the difference was statistically significant（P〈0.05）. The expression of osteoclast cells in primary active JIA group was higher than that in healthy control group, and the difference was statistically significant （P〈0.05） ; while the expression of osteoclast cells in remission JIA group was slightly higher than that in healthy control group with no significant difference（P〉0.05）. The expression of OPG was negatively correlated with DAS28 ,while RANKL/OPG was positively correlated with anti-CCP antibody （P〈0.05）. Conclusion The expression of RANKL was significantly increased in primary active group, and so was the expression of osteoclast ceils, which indicated that RANKL may promote the differentiation and maturation of osteoclasts cells.