沙利度胺联合甲氨蝶呤对类风湿性关节炎患者外周血调节性T细胞及细胞因子IL-6表达的调节作用

Effect of thalidomide combined with methotrexate on expression of regulatory T cells and IL-6 in rheumatoid arthritis

目的分析沙利度胺联合甲氨蝶呤（thalidomide＋methotrexate,T＋M）治疗类风湿性关节炎（rheumatoid arthritis,RA）前后调节性T细胞比例及细胞因子白介素-6（interleukin-6,IL-6）表达情况,揭示T＋M治疗RA作用机制。方法选取2014年8月-2016年8月温州医科大学附属第三医院血液科就诊治疗的类风湿性关节炎58例患者,沙利度胺联合甲氨蝶呤治疗前后流式细胞术检测外周血调节性T细胞比例,对比分析T＋M治疗前后调节性T细胞比例变化;酶联免疫吸附测定（enzyme linked immunosorbent assay,ELISA）检测外周血中淋巴细胞分泌细胞因子IL-6表达情况。结果 T＋M治疗后组RA患者外周血调节性T细胞（CD25^＋Foxp3/CD4^＋）比例较治疗前组明显增加;然而,T＋M治疗后组IL-6表达水平同治疗前组相比明显下降。结论 T＋M治疗RA可能是通过增加调节性T细胞以及减少细胞因子IL-6而调控T细胞稳态而起作用。

Objective To investigate the effect of before and after combination therapy of thalidomide and methotrexate（ T ＋ M） on regulatory T cells and IL-6 expression profile,and to reveal the mechanism of therapeutic effect of T ＋ M on rheumatoid arthritis. Methods A total of 58 patients with rheumatoid arthritis from August 2014 to August 2016 in the Third Affiliated Hospital of Wenzhou Medical University. The flow cytometry assay and enzyme-linked immunosorbent assay（ ELISA） were used to estimate the ratio of peripheral blood regulatory T cells and expression profile of IL-6 in peripheral blood lymphocyte before and after combination therapy of thalidomide and methotrexate. Results After combination therapy of T ＋ M,the ratio of peripheral blood CD25^＋Foxp3/CD4^＋T cells had a marked increase compared with before combination of therapy of T ＋ M; but the expression of IL-6had a significant decrease in the group of after combination therapy of T ＋ M compared with before combination therapy. Conclusion The effect of combination therapy of T ＋ M on rheumatoid arthritis is associated with increasing the ratio of regulatory T cells and decreasing the secretion of IL-6 that could regulate T cells to homeostasis.