滤泡辅助性T细胞在类风湿关节炎发病中的临床意义

ClinicaI significance of T follicuLar helper cells in rheumatoid arthritis

目的通过检测类风湿关节炎(RA)患者外周血滤泡辅助性T淋巴细胞(Tfh))和白细胞介素-21(IL-21)等的表达,探讨其在RA发病过程中可能的免疫学发病机制。方法根据病情活动度不同将病例组分为轻、中、重度活动组(各30例),健康对照组30例;流式细胞仪检测RA和健康对照组外周血单个核细胞(PBMCs)中CD4-异硫氰酸荧光素(FITC)、CXCR5-藻红蛋白(PE)、ICOS-别藻蓝蛋白(APC)标记的CD3+CD4+CXCR+、CD3+CD4+ICOS+及CD3+CD4+CXCR+ICOS+Tfh百分率;酶联免疫吸附试验(ELISA)检测IL-21、类风湿因子(RF-IgM)、抗环瓜氨酸肽(CCP)抗体(CCP-IgG)及红细胞沉降率(ESR)、C反应蛋白(CRP),分析其与Tfh的相关性。结果 RA轻、中、重度活动组患者外周血中Tfh百分率明显高于健康对照组(P<0.05);Tfh百分率随着RA活动度的增加呈上升趋势,组间差异有统计学意义(P<0.05);Tfh细胞百分率与RA患者ESR、CRP、RF及抗CCP抗体滴度呈正相关,差异有统计学意义(P<0.05)。结论 RA患者外周血Tfh、IL-21、CRP、ESR、RF及CCP水平明显升高,与疾病活动度等有明显相关性,提示Tfh细胞可能在RA发病中起着一定的作用。

Objective To investigate the percentages of T follicuLar helper cells （Tfh）and interleukin-21（IL-21）in the plasma of patients with rheumatoid arthritis,and the immunological mechanism of Tfh cells in the development of rheumatoid arthritis. Methods According to ACR and DAS28,patients with rheumatoid arthritis were divided into low,moderate and high activity group.The percentages of CD3 ^＋ CD4 ^＋ CXCR＋ 、CD3 ^＋ CD4 ^＋ ICOS^＋ and CD3 ^＋ CD4 ^＋ CXCR＋ ICOS^＋ Tfh cells were detected by Flow Cytometry.While the levels of IL-21 、RF-IgM and anti-CCP in plasma were measured by ELlSA test.The analysis was performed by t-test and Spearman′s correlation analysis.Results The expression of CD3 ^＋ CD4 ^＋ CXCR＋ ICOS^＋ Tfh cells in PBMCs of rheumatoid arthritis was significantly higher than that in the normal controls（P〈0.05）.Meanwhile the results of the three rheumatoid arthritis groups（low,moderate and high activity groups）showed that the expression of Tfh increased accordingly（P〈0.05）.The expression of Tfh in rheumatoid arthritis was positively related with the levels of IL-21 ,ESR,CRP,RF and anti-CCP respectively. Conclusion The expression of Tfh and IL-21 increases significantly and is closely related to the disease activity in rheumatoid arthritis.The results indicate that the abnormality of Tfh may play an important role in the pathogenesis of rheumatoid arthritis.