血清炎性活动指标、Th17/Treg细胞在溃疡性结肠炎患者中的改变及其临床意义

The expression of serum inflammatory markers and Th17/Treg cells in patients with ulcerative colitis and the clinical significance

目的检测溃疡性结肠炎(ulcerative colitis,UC)患者血清炎性活动指标血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、血小板(platelet,PLT)计数、平均血小板体积(mean platelet volume,MPV)、血小板分布宽度(platelet distribution width,PDW)、外周血辅助性T细胞17(Th17)和调节性T细胞(Treg)比例及相关细胞因子(IL-17、IL-10和TGF-β)的变化,探讨其与UC疾病活动度及炎症程度的关系。方法选取UC患者23例(活动期15例,缓解期8例),另取健康对照者8名。采用改良的Mayo评分系统评估UC患者疾病活动度;魏氏法检测ESR、散射光比浊法检测CRP、血细胞仪检测PLT计数、MPV和PDW水平;流式细胞仪检测外周血Th17/Treg细胞比例;ELISA双抗体夹心法检测外周血IL-17、IL-10和TGF-β的含量。结果活动期UC患者外周血Th17细胞比例显著高于缓解期UC患者及健康对照者(P<0.05);中度和重度活动期UC患者外周血Treg细胞比例显著低于缓解期UC患者及健康对照者(P<0.05);UC患者外周血Treg细胞比例与ESR、CRP、PLT和Mayo评分呈负相关,与MPV和PDW呈正相关(P均<0.05)。与缓解期UC患者及健康对照者相比,活动期UC患者血清中IL-17含量明显升高,IL-10和TGF-β的含量明显降低(P均<0.05)。结论 UC患者存在Th17/Treg细胞比例失衡,Treg细胞比例降低与血清炎性活动指标ESR、CRP、PLT水平和Mayo评分呈负相关,与MPV和PDW呈正相关,提示Th17/Treg细胞失衡与UC疾病活动度及炎症程度有关。

Objective To investigate the serum activity monitoring indicators,including erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,platelet（PLT） count,mean platelet volume（MPV）,platelet distribution width（PDW）,the percentage of Th17/Treg and the related cytokines（IL-17,IL-10 and TGF-β） levels of patients with ulcerative colitis（UC）. Methods Twenty-three patients with UC were enrolled,including 15 cases of active UC patients and 8 cases of inactive UC patients. Eight healthy individuals were selected as the normal controls. The activity of UC was evaluated by Mayo index. ESR and CRP were detected by Westgren method and Turbidimetric method of scattered light,respectively. PLT count,MPV and PDW were measured by the automatic blood cell analyzer. The percentages of peripheral blood Th17 and Treg cells in UC patients and normal controls were detected by flow cytometery; serum levels of IL-17,IL-10 and TGF-β were determined by ELISA. Results Th17 cells percentage in CD4＋T cells in active UC patients was absolutely higher than that in inactive UC patients and control groups（P〈0. 05）. Treg cells percentages in CD4＋T cells in moderate and severe active UC patients were both significantly lower than those in inactive UC patients and control groups（P〈0. 05）. The proportion of Treg cells was negatively related with ESR,CRP,PLT and Mayo score（P〈0. 05）,the proportion of Treg cells was positively related with MPV and PDW（P〈0. 05）. In addition,serum level of IL-17 was significantly increased while IL-10 and TGF-β were significantly decreased in active UC patients compared with those in inactive UC patients and control groups（P〈0. 05）. Conclusion The imbalance of Th17/Treg cells has a closed relationship with the immune inflammatory reaction of UC patients. The correlations between the Treg cells percentage and the serum inflammatory biomarkers indicate that the differentiation imbalance of Th17/Treg may be involved in the pathogenesis of UC.