幼年特发性关节炎患儿白内障术后眼内炎症与血清细胞因子的关系

Serum Cytokine Profiles Associated with Intraocular Inflammation after Cataract Surgery in Children with Juvenile Idiopathic Arthritis

目的:探讨Th17、Th1和调节性T细胞相关促炎细胞因子在幼年特发性关节炎(JIA)患儿白内障术后眼内炎症反应中的作用。方法:回顾性病例对照研究。收集2013年7月至2018年3月于内蒙古自治区人民医院眼科就诊的32例JIA患儿(JIA组)和35例先天性白内障患儿(先天性白内障组)在白内障手术前及术后1、7、30、90 d的血清以及手术开始时的房水。采用多组别免疫分析系统测定血清和房水中白细胞介素-1β(IL-1β)、IL-6、IL-10、IL-23、IL-27、IL-17和干扰素-γ(IFN-γ)的蛋白水平。激光蛋白细胞检测仪用于定量眼内炎症。采用重复测量方差分析对数据进行统计学分析,用Spearman相关系数法计算JIA患者血清IL-6、IL-23和IFN-γ水平与房水闪辉值和细胞计数之间的相关性。结果:JIA组术后1 d血清IL-23[(612±190)pg/ml]、IL-6[(305±82)pg/ml]、IFN-γ[(172±43)pg/ml]、IL-10[(202±114)pg/ml]、IL-27[(110±43)pg/ml]和IL-1β[(106±27)pg/ml]均明显升高,术后90 d逐渐恢复至术前水平。JIA组术前及术后1、7、30、90 d血清IL-1β、IL-6、IL-23、IL-27、IL-10和IFN-γ均明显高于先天性白内障组。JIA患者血清的IL-6水平(r=0.085,P=0.002)、IFN-γ水平(r=0.741,P=0.021)、IL-23水平(r=0.622,P=0.028)与房水闪辉值均有相关性,IL-6水平(r=0.729,P=0.006)、IFN-γ水平(r=0.669,P=0.019)与前房细胞数均有相关性,IL-23水平与前房细胞数无明显相关性(r=0.646,P=0.051)。结论:Th17、Th1和调节性T细胞相关促炎细胞因子IL-6和IFN-γ在JIA患儿血清中水平的升高可反映患者眼内炎症活动情况,血清IL-23、IL-10、IL-27和IL-1β的变化也可以用于评估JIA患者白内障术后眼内炎症的情况。

Objective:To investigate the role of Th17,Th1 and regulatory T cell(Treg)-related pro-inflammatory cytokines on postoperative inflammation in children with juvenile idiopathic arthritis(JIA).Methods:This was a retrospective case-control study.Serum from 32 children with JIA and 35 controls with congenital cataract in Inner Mongolia Autonomous Region People's Hospital from July 2013 to March 2018 were ennolled before surgery and 1,7,30 and 90 days after surgery,and aqueous humor(AqH)was collected at the commencement of surgery.Protein levels of inter leukin-1 beta(IL-1β),IL-6,IL-10,IL-23,IL-27,IL-17 and IFN-gamma in serum and AqH were determined by the multiplexed immunoassay method.A laser flare-cell photometer was used to quantify intraocular inflammation.Repeated measurements of variance was used for statistical analysis of data.A Spearman correlation coefficient test was used to evaluate the correlation between the protein levels of IL-6,IL-23,IFN-gamma in serum and AqHand intraocular inflammation in JIA patients.Results:Serum IL-1β(106±27 pg/ml),IL-6(305±82 pg/ml),IL-10(202±114 pg/ml),IL-23(612±190 pg/ml),IL-27(110±43 pg/ml)and IFN-gamma(172±43 pg/ml)levels were significantly higher in children with JIA when compared to control patients after the first day postoperatively,decreased rapidly,and attenuated gradually.AqH levels of the cytokines were below the detection level in children with JIA and controls.Notably,the following serum levels were strongly correlated with aqueous flare values in children with JIA:Serum IL-6 levels(r=0.085,P=0.002),serum IFN-gamma levels(r=0.741,P=0.021),serum IL-23 levels(r=0.622,P=0.028).Serum IL-6 levels(r=0.729,P=0.006),and serum IFN-gamma levels(r=0.669,P=0.019)correlated with aqueous cells.Serum IL-23 levels were not correlated with AqH in children with JIA(r=0.646,P=0.051).Conclusion:The increase in the number of Th17,Th1 and regulatory T cell related proinflammatory cytokines IL-6 and IFN-gamma can reflect inflammation in JIA children's eyes after surgery.Serum IL-1beta,IL-10,IL-23 and IL-27 levels can be used to evaluate postoperative intraocular inflammation.