Th17/Treg在幼年特发性关节炎合并特应质中的研究

Th17/Treg in juvenile idiopathic arthritis with atopy

目的探讨特应质对幼年特发性关节炎(JIA)患儿病情活动的影响,以及Th17/Treg失衡的作用。方法入选47例JIA合并特应质(特应质组)、64例单纯JIA(单纯组)及20例健康对照儿童(对照组)。ELISA方法检测血清IL-1β、IL-6、IL-17水平,流式细胞术检测外周血Th17、Treg细胞在淋巴细胞中的比例,RT-qPCR检测外周血单个核细胞IL-17mRNA、Foxp3mRNA表达,比较三组间的差异;同时比较两组JIA患儿疾病活动指标的差异。结果对照组、单纯组和特应质组之间,血清IL-1β、IL-6、IL-17水平,Th17、Treg细胞在淋巴细胞中的比例以及IL-17mRNA、Foxp3mRNA表达水平的差异均有统计学意义(P<0.01)。特应质组与单纯组血清IL-1β、IL-6、IL-17水平均高于对照组,特应质组高于单纯组,差异均有统计学意义(P<0.05)。特应质组Th17细胞在淋巴细胞中的比例以及IL-17mRNA表达水平最高,对照组最低。特应质组Treg细胞在淋巴细胞中的比例最低,对照组最高。特应质组血小板计数、医师对疾病总体评估(PGA)、患者/家长对疾病总体评估(PGE)、患儿健康评估问卷调查(CHAQ)、活动关节炎数目、活动受限关节数目、JADAS27评分均明显高于单纯组,差异有统计学意义(P<0.05)。结论JIA合并特应质患儿的疾病活动性更高,可能与IL-1β、IL-6水平升高、Th17/Treg平衡更偏向Th17方向发展有关。

Objective To explore the effects of atopy on the disease activity of juvenile idiopathic arthritis (JIA) in children and the role of Th17/Treg imbalance. Methods Forty-seven JIA patients with atopy (atopic group), 64 patients with simple JIA (simple group) and 20 healthy control children (control group) were enrolled. The levels of IL-1β, IL-6, and IL- 17 in serum were detected by ELISA, the ratio of Th17 and Treg cells in peripheral blood lymphocytes was detected by flow cytometry, and the expressions of IL-17 and Foxp3 in peripheral blood mononuclear cells were detected by RT-q PCR. The differences in above indicators between the three groups were compared. Meanwhile, the difference of disease activity index between the two JIA groups was compared. Results The serum levels of IL-1β, IL-6 and IL-17, the ratio of Th17 and Treg cells in lymphocytes and the expression levels of IL-17mRNA and Foxp3 mRNA were significantly different among control group, simple JIA group and atopic group (all P< 0.01). The serum levels of IL-1β, IL-6, and IL-17 in the atopic group and the simple JIA group were higher than those in the control group, and theywere higher in the atopic group than in thesimple group. The differences are statistically significant (all P<0.05). The percentage of Th17 cells in lymphocytes and the expression levels of IL- 17 mRNA were the highest in the atopic group and the lowest in the control group. The percentage of Treg cells in lymphocytes was the lowest in the atopic group and the highest in the control group. The platelet count, physician global assessment of disease activity (PGA), patient or parent global evaluation of well-being (PGE), children health assessment questionnaire (CHAQ), active joint count, restricted joint countand juvenile arthritis disease activity score (JADAS)-27 in atopic group were significantly higher than those in simple JIA group, and the difference was statistically significant (all P<0.05). Conclusion Higher disease activity in JIA children with atopy may be related to increased IL-1β and IL-6 levels and Th17/Treg imbalance more toward Th17.