外周血淋巴细胞和CD4^+T细胞在类风湿关节炎中的表达和意义

Expression and Significance of Peripheral Blood Lymphocytes and CD4^+T Cell Subsets in Rheumatoid Arthritis

目的研究外周血淋巴细胞亚群绝对数量及CD4+T细胞亚群绝对数量在类风湿关节炎患者中的表达机制及临床意义。方法入组137例RA患者和50例健康人用流式细胞技术检测外周血淋巴细胞亚群及CD4+T细胞亚群绝对计数,并收集临床资料包括性别、年龄、病程、DAS28评分等;比较早期RA患者(病程≤2年)与非早期RA患者(病程>2年)淋巴细胞亚群及CD4+T细胞亚群绝对计数,评估不同病程RA患者的免疫功能;比较初治(初发患者)、复治患者(使用DMARDs≥6个月)与健康人CD4+T细胞亚群绝对计数,评估治疗与未治疗对RA患者免疫状态的影响;按DSA28评分分层,比较不同疾病活动组与健康对照组Th17、Treg细胞绝对计数及Th17/Treg比值的不同。结果RA患者Th细胞明显高于健康对照组、NK细胞明显低于健康对照组,差异均有统计学意义(P<0.05);Th1、Th2、Treg、Th1/Th2、Th17/Treg与健康对照组比较,差异均有统计学意义(P<0.05);非早期RA患者总T、Th17细胞明显低于早期RA患者,差异有统计学意义(P<0.05);初治组、复治组与健康对照组CD4+T细胞亚群比较,Th1、Th2、Th1/Th2、Th17/Treg差异均有统计学意义(P<0.05);在RA不同疾病活动分层中,Treg细胞绝对数均低于健康对照组,Th17细胞绝对数高于健康对照组。其中3.2<DSA28≤5.1组Th17细胞绝对数与健康人比较,差异有统计学意义(P<0.05)。Th17/Treg在DSA28≤3.2组及3.2<DSA28≤5.1组均明显高于对照组,差异有统计学意义(P<0.05)。结论与健康人比较,Th1/Th2、Th17/Treg平衡紊乱可能是RA发生、发展的重要机制,为临床医生进一步认识类风湿关节炎的发病和临床治疗提供了一定的基础认识。

Objective To research the expression mechanism and clinical significance of absolute numbers of lymphocyte subsets and CD4+T cell subsets in peripheral blood in patients with rheumatoid arthritis.Methods A total of 137 patients with RA and 50 healthy volunteers were enrolled.The lymphocyte subsets and CD4+T cell subsets in peripheral blood were measured by FCM,and clinical data including gender,age,disease duration,DAS28 score were collected.The absolute counts of lymphocyte subsets and CD4+T cell subsets in peripheral blood in early RA patients(disease duration≤2 years)and established RA patients(disease duration>2 years)were compared to evaluate the immune function of patients with different disease courses.The absolute counts of CD4+T cell subsets in peripheral blood in first-therapy(newly diagnosed)and retherapy(DMARDs≥6 months)patients and healthy controls were compared to evaluate the effect of treatment and non-treatment on the immune status of RA patients.Stratified according to the DSA28 score,the absolute counts of Th17 cells and Treg cells and the ratio of Th17 versus Treg cells in peripheral blood between different disease activity groups and the healthy control group were compared.Results The levels of helper T cells in RA patients were significantly higher than those of healthy controls(P<0.05),while the levels of NK cells were significantly lower than those of healthy controls(P<0.05).The absolute counts of Th1,Th2,Treg and the ratio of Th1/Th2 and Th17/Treg in RA patients had significant differences compared with those in healthy controls(P<0.05).The levels of total T cells and Th17 cells in established RA patients were significantly lower than those in early RA patients.The absolute counts of Th1,Th2 and the ratio of Th1/Th2 and Th17/Treg in first-therapy and retherapy patients and healthy controls all had statistically significant differences(P<0.05).In RA patients with different disease activity scores,the absolute counts of Treg cells were all lower than those in healthy controls while the absolute counts of Th17 cells were all higher than those in healthy controls,and only the absolute counts of Th17 cells in patients with 3.2<DSA28≤5.1 had statistically significant differences compared with healthy controls.The ratio of Th17/Treg in patients with DSA28≤3.2 and 3.2<DSA28≤5.1 were significantly higher than those in healthy controls(P<0.05).Conclusion The imbalance of Th1/Th2 and Th17/Treg may play a vital role in pathogenesis of RA,providing a certain basis for clinicians to further understand the pathogenesis and clinical treatment of rheumatoid arthritis.