类风湿关节炎血清CXCL13演变的临床意义

Clinical significance of serum CXCL13 change in rheumatoid arthritis

目的观察随访类风湿关节炎（RA）患者血清CXCL13的变化，探讨其在RA患者中的意义。方法收集2014年6月至2017年6月郑州大学人民医院初治RA患者（RA组）15例及正常健康人（对照组）21例，收集其血清。对15例初治RA患者进行随访，分别收集其治疗前及治疗后3、6、12个月的血清。采用酶联免疫吸附方法（ELISA）检测血清CXCL13水平；收集患者的临床资料，包括姓名、性别、年龄、肿胀关节数（28个关节）、压痛关节数（28个关节）、患者对疾病的总体评价、医生对疾病的总体评价。根据上述数据，计算28个关节的疾病活动评分[DAS28（ESR）, DAS28（CRP）]、简化的疾病活动性指（SDAI）、临床疾病活动性指数数（CDAI）。观察随访15例患者的CXCL13的变化。结果①CXCL13水平初治时为（147.03±56.26） pg/ml，3个月时为（86.55±61.39） pg/ml，6个月时为（63.81±32.68） pg/ml，12个月时为（90.71±39.08） pg/ml，均高于对照组的（42.24±11.21）pg/ml，差异有统计学意义（P〈0.05）。②DAS28（CRP）、CDAI、SDAI变化趋势同DAS28（ESR）。③CXCL13在第3、6个月时呈逐渐下降趋势，与DAS28（ESR）、DAS28（CRP）、CDAI、SDAI变化趋势一致；第12个月时，CXCL13较第6个月时升高，而DAS28（ESR）、DAS28（CRP）、CDAI、SDAI呈继续下降趋势，这与CXCL13变化趋势不一致。结论血清CXCL13水平在RA患者中显著升高，随访RA患者中CXCL13水平逐步下降后再次升高，说明CXCL13可作为评价初治RA疾病活动度的指标，可以初步判断RA的疗效，可能参与RA的发病机制。

ObjectiveTo observe and follow up the changes of serum CXCL13 in rheumatoid arthritis （RA） patients and to investigate its significance on RA patients. MethodsBlood samples were collected from 15 primary RA patients （RA group） and 21 healthy controls （HC group） who visited clinic in People’s Hospital of Zhengzhou University from June 2014 to June 2017. Fifteen primary RA patients were followed up, and their blood samples were collected before treatment and at 3, 6 and 12 months after treatment, respectively. Serum CXCL13 were detected by enzyme-linked immunosorbent assay. Information on clinical symptoms and the findings of physical examinations was collected including name, gender, age, tender and swollen joint count （28 joints）, general assessment of disease activity by patient, general assessment of disease activity by doctor, and thus the disease activity score （DAS） in 28 joints with erythrocyte sedimentation rate （ESR）-based or C-reative protein （CRP）-based, simplified disease activity index （SDAI）, and clinical disease activity index （CDAI） were calculated according to the above data. The level of serum CXCL13 in 15 cases of follow-up RA patients was analyzed. Results① The CXCL13 level was （147.03±56.26） pg/ml before initial treatment, （86.55±61.39） pg/ml at 3 months after treatment, （63.81±32.68） pg/ml at 6 months after treatment, and （90.71±39.08） pg/ml at 12 months after treatment, which were all significantly higher than the level of HC group [（42.24±11.21）pg/ml], P〈0.05. ② The tendency of DAS28（CRP）, CDAI and SDAI were similar to DAS28（ESR）. ③ CXCL13 level had entered in a downtrend at 3 and 6 months after treatment, which was similar to the tendency of DAS28（ESR）, DAS28（CRP）, CDAI, SDAI. CXCL13 level at 12 months after treatment was higher than that at 6 months, but DAS28（ESR）, DAS28（CRP）, CDAI, SDAI had a downtrend, which was different from tendency of serum CXCL 13. ConclusionsSerum CXCL13 level is significantly higher in RA patients and its level is in a downtrend in the first few months and then increased, which suggests that serum CXCL13 level may serve as clinical markers of assessment on disease activity and treatment response, that is serum CXCL13 may contribute to the pathogenesis of RA.