未治疗大动脉炎患者临床特征与免疫状态及淋巴细胞亚群特点分析

Clinical characteristics,immune status and lymphocyte subsets of patients with untreated Takayasu arteritis

目的探讨未经激素和免疫抑制剂治疗的大动脉炎患者的临床特征与自身免疫状态及淋巴细胞亚群的状况,旨在为免疫治疗提供指导。方法采用横断面调查研究。选择首都医科大学附属北京安贞医院2018年1月至2019年11月在风湿免疫科和血管科就诊的大动脉炎患者29例,女性28例、男性1例,中位数年龄为39岁,患者均符合美国风湿病学会大动脉炎诊断标准,且未经激素和免疫抑制剂治疗,收集这些患者的临床资料,同时进行免疫学指标和外周血淋巴细胞亚群的检测。同期选择21名健康正常人作为对照组,进行免疫学指标和外周血淋巴细胞亚群的检测。采用卡方检验、独立样本t检验和非参数检验等方法进行统计学分析。结果未治疗的29例大动脉炎患者中,28例为女性,26例患者处于疾病活动期;全身症状中以乏力(62.07%)和头痛(41.38%)为主要表现,血管症状中以杂音和脉搏减弱(68.97%)为主要表现,Numano分型中以Ⅴ型(79.31%)最多。与健康对照者组相比,初诊大动脉炎患者的总T(CD3)淋巴细胞的绝对值[(1337.14±312.46)μl vs(1139.95±340.96)μl,t=2.120,P=0.039]、辅助T(CD4)淋巴细胞的百分比[46.29%±6.55%vs 36.55%±7.42%,t=4.903,P<0.0001]和绝对值[(815.52±194.11)μl vs(571.44±187.55)μl,t=4.450,P<0.0001]、CD4/CD8的比值[1.83(1.41~2.30)vs 1.32(1.03~1.39),Z=3.401,P=0.001]都升高,而自然杀伤(NK)细胞(CD56)的百分比[10.71%(6.45%~14.30%)vs 14.57%(10.87%~18.47%),Z=2.408,P=0.016]降低。与健康对照者组相比,大动脉炎患者的补体C3[1.16(1.02~1.31)g/L vs 1.05(0.93~1.15)g/L,Z=2.383,P=0.021]升高,免疫球蛋白(Ig)G[11.97(8.74~14.43)g/L vs 14.37(13.11~15.47)g/L,Z=3.017,P=0.003]降低。与健康对照者组相比,初诊大动脉炎患者的炎症指标红细胞沉降率(ESR)[19.31(9.50~28.50)mm/h vs 3.71(2.00~5.00)mm/h,Z=5.338,P<0.0001]、高敏C反应蛋白(hs-CRP)[6.52(0.32~8.62)mg/L vs 0.73(0.35~1.07)mg/L,Z=2.983,P=0.003]和快速C反应蛋白(Q-CRP)[8.73(1.03~7.72)mg/L vs 0.57(0.08~0.98)mg/L,Z=4.263,P<0.0001]都升高。结论未经激素和免疫抑制剂治疗的大动脉炎患者的自身免疫处于激活状态,外周血中的总T淋巴细胞和辅助性T淋巴细胞明显升高,以应对全身大动脉血管的炎症反应。

Objective This study mainly discussed the clinical characteristics,autoimmune status and lymphocyte subsets of patients with Takayasu arteritis(TA)without hormone and immunosuppressive therapy,in order to provide guidance for immunotherapy.Methods Using cross-sectional study,twenty-nine patients with TA admitted to the Department of Rheumatology and the Department of Vasculitis of Beijing Anzhen Hospital from January 2018 to November 2019 were selected,including 28 females and 1 male,with the middle age of 39 year.These patients met the diagnostic criteria of American Society of Rheumatology for TA,and were not treated with hormone and immunosuppressant.Clinical data of these patients were collected,and the immunological indexes and lymphocyte subsets of peripheral blood were detected simultaneously.At the same time,the immunological indexes and peripheral blood lymphocyte subsets of 21 healthy normal people were detected as control.Chi square test,independent sample t test and nonparametric test were used for analysis.Results Among the 29 patients with TA,28 were female,26 were in the active stage of disease;the main manifestations of systemic symptoms were malaise(62.07%)and headache(41.38%),the main manifestations of vascular symptoms were bruits and pulse weakening(68.97%),and the most of Numano type was V type(79.31%).The absolute value of total T(CD3)lymphocytes[(1337.14±312.46)μl vs(1139.95±340.96)μl,t=2.120,P=0.039],the percentage[46.29%±6.55%vs 36.55%±7.42%,t=4.903,P<0.0001]and the absolute value[(815.52±194.11)μl vs(571.44±187.55)μl,t=4.450,P<0.0001]of helper T(CD4)lymphocytes,the ratio of CD4/CD8[1.83(1.41-2.30)vs 1.32(1.03-1.39),Z=3.401,P=0.001]were higher compared with those of healthy controls,while the percentage of natural killer(NK)cells(CD56)[10.71%(6.45%-14.30%)vs 14.57%(10.87%-18.47%),Z=2.408,P=0.016]decreased.The complement C3[1.16(1.02-1.31)g/L vs 1.05(0.93-1.15)g/L,Z=2.383,P=0.021]in patients with TA was higher than those in healthy controls and immunoglobulin(Ig)G[11.97(8.74-14.43)g/L vs 14.37(13.11-15.47)g/L,Z=3.017,P=0.003]in patients with TA was lower than those in healthy controls.Compared with the control group,the ESR[19.31(9.50-28.50)mm/h vs 3.71(2.00-5.00)mm/h,Z=5.338,P<0.0001],hs-CRP[6.52(0.32-8.62)mg/L vs 0.73(0.35-1.07)mg/L,Z=2.983,P=0.003]and Q-CRP[8.73(1.03-7.72)mg/L vs 0.57(0.08-0.98)mg/L,Z=4.263,P<0.0001]of patients with TA were all increased.Conclusions The autoimmunity of patients with TA without hormone or immunosuppressant treatment is in active state,and the total T-lymphocytes and helper T-lymphocytes in peripheral blood are significantly increased in order to cope with the inflammatory response of the systemic artery vessels.