来氟米特联合羟氯喹治疗对类风湿关节炎患者外周血IL-17、IL-23、TGF-β表达的影响

Effect of leflunomide combined with hydroxychloroquine on the expression of IL-17,IL-23 and TGF-β in peripheral blood of patients with rheumatoid arthritis

目的研究来氟米特联合羟氯喹治疗类风湿关节炎(RA)患者外周血中白细胞介素(IL)-17、IL-23、转化生长因子β(TGF-β)的表达及临床意义。方法选取2015年10月~2017年10月确诊的初诊RA患者50例为观察组,选取50例在门诊体检中心健康体检者为健康对照组。所有患者均给予口服来氟米特联合硫酸羟氯喹治疗,观察3个月。治疗前1天及治疗后第3个月收集患者血清,采用酶联免疫吸附法(ELISA)检测细胞因子IL-17、IL-23、TGF-β的表达水平,同时收集患者血沉(ESR)、C反应蛋白(CRP)、类风湿因子(RF),并记录肿胀关节数(SJC)、压痛关节数(TJC)等临床资料。分析比较两组间IL-17、IL-23、TGF-β表达水平的差异,研究来氟米特联合羟氯喹治疗RA患者前后免疫细胞因子的变化特点,探讨其可能的作用机制。结果 RA患者外周血中IL-17、IL-23、TGF-β水平明显高于健康对照组,差异有统计学意义(P<0.05)。经治疗3个月后,RA患者外周血IL-17、IL-23、TGF-β的表达水平与治疗前相比明显降低,差异有统计学意义(P<0.05)。RA患者外周血中ESR、CRP、RF明显高于健康对照组(P<0.05);治疗后其水平明显降低,差异有统计学意义(P<0.05),关节疼痛数、关节肿胀数与治疗前比较明显降低(P<0.05)。结论 RA患者外周血IL-17、IL-23、TGF-β的表达水平高于正常人群,经来氟米特联合羟氯喹治疗3个月后,其表达水平明显下降,且临床观察指标也明显降低,提示来氟米特联合羟氯喹治疗可缓解RA的临床症状,同时可降低IL-17、IL-23、TGF-β细胞因子的表达水平。

Objective To study the expression and clinical significance of leflunomide combined with hydroxychloroquine in peripheral blood interleukin-17（ IL-17）,interleukin-23（ IL-23） and transforming growth factor β（ TGF-β） in patients with rheumatoid arthritis（ RA）.Methods 50 patients with newly diagnosed RA from October 2015 to October 2017 were selected as observation group,and 50 cases from the medical check-up center of our hospital were selected as control group.All patients were treated with leflunomide combined with hydroxychloroquine sulfate for 3 months.The serum levels of the patients were collected 1 day before treatment and at the third month after treatment.The expression levels of IL-17,IL-23 and TGF-βwere detected by enzyme linked immunosorbent assay（ ELISA）.Meanwhile,erythrocyte sedimentation rate（ ESR）,C-reactive protein（ CRP） and rheumatoid factor（ RF） of the patients were collected,and clinical data like swollen joint count（ SJC）and tender joint count（ TJC） were recorded.The expression levels of IL-17,IL-23 and TGF-β between the two groups were analyzed and compared,the changes of immune cytokines in RA patients before and after treatment with leflunomide combined with hydroxychloroquine were studied,and its possible mechanism action was explored. Results The levels of IL-17,IL-23 and TGF-β in peripheral blood of RA patients were significantly higher than those in the control group,difference was statistically significant（ P〈0.05）.After 3 months of treatment,the expression levels of IL-17,IL-23 and TGF-β in peripheral blood of RA patients were significantly lower than those before treatment,and the difference was statistically significant（ P〈0.05）.The ESR,CRP and RF in peripheral blood of RA patients were significantly higher than those in the control group（ P〈0.05）,and the above-mentioned levels of the patients were significantly lower after treatment,the difference was statistically significant（ P〈0.05）.The number of joint pain and joint swelling significantly reduced compared with those before treatment（ P〈0. 05）.Conclusion The expression levels of IL-17,IL-23 and TGF-β in the peripheral blood of RA patients are higher than those of healthy people.After 3 months of treatment with leflunomide combined with hydroxychloroquine,the expression levels obviously decrease,and the clinical observation indexes also significantly decrease. These results suggest that leflunomide combined with hydroxychloroquine can relieve the clinical symptoms of RA and decrease the expression levels of IL-17,IL-23 and TGF-β cytokines.