血清IL-17、IL-23水平对雷公藤多苷治疗类风湿关节炎的预后评估价值

Evaluation of Serum IL-17 and IL-23 in the Prognosis of Patients with Rheumatoid Arthritis Treated by Tripterygium Glycosides

目的:研究白细胞介素17(interleukin-17,IL-17)、白细胞介素23(interleukin-23,IL-23)对雷公藤多苷(tripterygium glycosides,TG)治疗类风湿关节炎(rheumatoid arthritis,RA)的预后评估价值。方法:120例RA患者均采用甲氨蝶呤片联合TG治疗,其中失访14例,根据治疗后6个月预后情况将患者分为良好组81例与不良组25例。比较两组患者血清IL-17、IL-23水平及其他RA预后可能的影响因素;Logistic回归分析方法分析RA预后影响因素;绘制受试者工作ROC曲线,分析血清IL-17、IL-23对RA预后的预测价值,并采用Kappa一致性检验方法分析血清IL-17联合IL-23预测RA预后的效能。结果:与良好组比较,不良组28个关节疾病活动度评分(DAS28)、人类白细胞抗原-DR4(HLA-DR4)阳性构成比,血清IL-17、IL-23水平均较高,差异有统计学意义(P<0.05);Logistic回归分析显示,DAS28评分、HLA-DR4阳性、IL-17、IL-23均是TG治疗RA预后不良的影响因素(P<0.05);ROC结果显示,血清IL-17、IL-23预测RA预后不良的最佳截断点分别为22.24 ng/L、140.67 ng/L,曲线下面积分别为0.786、0.723;血清IL-17联合IL-23预测RA预后不良的效能较高(Kappa=0.801,P<0.05)。结论:RA患者血清IL-17、IL-23水平异常升高,两者联合检测在TG治疗RA的预后评估中具有重要价值。

Objective:To assess the values of IL-17 and IL-23 in the prognosis of patients with rheumatoid arthritis(RA)treated by tripterygium glycosides(TG).Methods:All 120 RA patients were treated by methotrexate tablets and TG,and 14 cases were lost,and the remaining patients were divided into 81 cases of good prognosis group and 25 cases of poor prognosis group according to the prognosis six months after the treatment.To compare the levels of IL-17 and IL-23 between both groups,and other possible influencing factors of the prognosis of RA;Logistic regression analysis method was used to analyze the influencing factors of the prognosis of RA;ROC was drawn to analyze the predictive values of IL-17 and IL-23 on the prognosis of RA,Kappa consistency test was adopted to analyze the efficacy of IL-17 and IL-23 in the prediction of RA prognosis.Results:Compared with good prognosis group,the scores of DAS28,constituent ratio of positive HLA-DR4,the levels of IL-17 and IL-23 were higher in the poor prognosis group,and the difference had statistical meaning(P<0.05);Logistic regression analysis showed that DAS28 scores,positive HLA-DR4,IL-17 and IL-23 were the influencing factors for the poor prognosis of treating RA by TG(P<0.05);ROC results displayed that the optimal cut-off points for IL-17 and IL-23 to predict the poor prognosis of RA were 22.24 ng/L and 140.67 ng/L respectively,AUC were 0.786 and 0.723 respectively;IL-17 and IL-23 had high efficacy in predicting poor prognosis of RA(Kappa=0.801,P<0.05).Conclusion:RA patients manifest abnormal increase of IL-17 and IL-23,the combined detection of both is of great value in the prognosis evaluation of treating RA with TG.