青风藤汤联合甲氨蝶呤对类风湿关节炎患者滤泡辅助性T细胞及白介素-21的影响

Effect of Qingfengteng Decoction Combined with Methotrexate on Peripheral Blood Follicular Helper T Cell and Interleukin-21 in Rheumatoid Arthritis Patients

目的观察青风藤汤联合甲氨蝶呤(MTX)对初诊类风湿关节炎(rheumatoid arthritis,RA)患者滤泡辅助性T细胞(follicular helper T cell,Tfh)、白介素-21(IL-21)及病情活动度的影响。方法将72例初诊RA患者随机分为对照组和观察组,每组36例。两组均予MTX,10 mg/周;塞来昔布0.2 g,每日2次口服治疗,根据临床症状逐渐减停塞来昔布。观察组加青风藤汤口服。连续用药12周。治疗前及治疗4、8、12周检测患者红细胞沉降率(erythrocyte sedimentation rate,ESR),并计算患者28个关节病情活动指数(disease activity score in 28 joints,DAS28)。治疗前及治疗12周采用流式细胞术检测外周血Tfh细胞数量,采用酶联免疫吸附法检测治疗前后血清IL-21、抗环瓜氨酸(anti-cyclic citrullinated peptide antibody,抗CCP)抗体。结果两组患者治疗4、8、12周时ESR及DAS28均有降低(P<0.01)。治疗12周时,观察组DAS28较对照组同期更低(P<0.01)。治疗前及治疗12周两组患者抗CCP抗体无明显差异(P>0.05)。与健康人群比较,治疗前两组患者Tfh/CD_4^+ T细胞比例、IL-21水平均明显升高(P<0.01)。与治疗前比较,治疗12周时两组患者Tfh/CD_4^+ T细胞比例、IL-21水平均明显降低,且观察组低于对照组(P<0.01,P<0.05)。结论青风藤汤联合MTX可降低RA患者的Tfh及IL-21水平,并改善患者的临床症状。

Objective To observe the effect of Qingfengteng Decoction （QFTD） combined with Methotrexate （MTX） on peripheral blood follicular helper T cell （Tfh）, IL-21, and disease activity in rheumatoid arthritis （RA） patients at the first visit. Methods Totally 72 early RA patients were randomly assigned to the research group and the control group, 36 cases in each group. All patients took MTX （10 mg once a week） and Celecoxib （0.2 g/capsule, twice per day; the dosage of celecoxib was tapered according to clinical symptoms）. Patients in the research group additionally took QFTD. The treatment course for all was 12 weeks. Erythrocyte sedimentation rate （ESR） and Disease Activity Score in 28 joints （DAS28） were measured before treatment, at week 4, 8, and 12 weeks. Tfh count in peripheral blood was detected by flow cytometry before treatment and at week 12 after treatment. Serum contents of IL-21 and anti-cyclic citrullinated peptide （anti-CCP） antibody were detected by enzyme linked immunosorbent assay （ELISA） before and after treatment. Results Compared with before treatment in the same group, ESR and DAS28 in the both two groups decreased at week 4, 8, and 12 （P 〈0.01 ）. DAS28 of the research group was lower than that in the control group at week 12 （P 〈0.01 ）. There was no significant difference in anti-CCP antibody in the two groups between before treatment and at week 12 after treatment （P 〉 0.05）. Compared with the healthy population, the proportion of Tfh/CD^＋T and the IL-21 level increased in the two groups before treatment （P 〈0.01 ）. Compared with before treatment in the same group, the proportion of Tfh/CD4^＋T and the IL-21 level decreased in the two groups at week 12. Besides, they were lower in the research group than in the control group （P 〈0.01, P 〈0.05）. Conclusion QFTD combined with MTX could decrease Tfh and IL-21 level in RA patients, and improve clinical symptoms of KOA patients.