不同分期痛风性关节炎患者NALP3炎性体及外周血γδT细胞水平观察

Observation of NALP3 inflammasome and peripheral bloodγδT cell levels in gouty arthritis patients with different stages

目的观察不同分期痛风性关节炎(GA)患者NALP3炎性体及外周血γδT细胞水平。方法回顾性选取2022年7月至2023年7月在河北省沧州中西医结合医院接受治疗的96例GA患者作为研究对象。依据GA临床分期,分为急性关节炎期组(n=38)、间歇期组(n=26)、慢性关节炎期组(n=32)。另选取同期于本院体检中心体检的健康者35名设为对照组。观察各组NALP3炎性体及外周血γδT细胞水平,分析各组GA患者的临床指标,包括血尿酸、血肌酐、总胆固醇、甘油三酯、血清C反应蛋白(CRP)水平及白细胞计数(WBC)。采用Pearson相关性分析急性关节炎期患者外周血γδT细胞及其亚型、NALP3炎性体与临床指标的关系。结果各组NALP3、γδT1细胞比较,差异均无统计学意义(P>0.05);各组Caspase-1、ASC、γδT细胞、γδT2细胞比较,差异均有统计学意义(P<0.05),其中,急性关节炎期组、间歇期组、慢性关节炎期组Caspase-1水平均高于对照组,γδT细胞和γδT2细胞比例均低于对照组,且病情程度越高,Caspase-1水平越高,γδT细胞和γδT2细胞比例越低;急性关节炎期组、间歇期组、慢性关节炎期组ASC水平均高于对照组,但急性关节炎期组低于间歇期组、慢性关节炎期组,差异均有统计学意义(P<0.05)。各组总胆固醇、甘油三酯、CRP水平比较,差异均无统计学意义(P>0.05);各组血尿酸、WBC、血肌酐水平比较,差异均有统计学意义(P<0.05),其中,急性关节炎期组、间歇期组、慢性关节炎期组的血尿酸、WBC、血肌酐水平均高于对照组,差异均有统计学意义(P<0.05),且病情程度越高,血尿酸、WBC、血肌酐水平越高。相关性分析显示,γδT细胞在淋巴细胞中的比例及γδT1细胞在γδT细胞中的比例与血尿酸、血肌酐、总胆固醇、甘油三酯、WBC、CRP指标无明显相关性;γδT2在γδT细胞中的比例与甘油三酯、WBC呈负相关(P<0.05)。相关性分析显示,NALP3 mRNA表达与血肌酐、总胆固醇、甘油三酯、WBC指标无明显相关性;与血尿酸、CRP呈正相关(P<0.05)。结论NALP3炎性体及外周血γδT细胞参与GA的发展,Caspase-1、γδT细胞和γδT2细胞可作为痛风的急性炎症标记物,而ASC不能作为痛风的急性炎症标记物,同时γδT2在γδT细胞中的比例与甘油三酯、WBC呈负相关,NALP3 mRNA表达与血尿酸、CRP呈正相关,为临床病情评估和治疗提供参考。

Objective To observe the levels of NALP3 inflammasome and peripheral bloodγδT cells in gouty arthritis(GA)patients with different stages.Methods A total of 96 GA patients treated in Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2022 to July 2023 were selected and studied.According to the clinical stages of GA,they were divided into the acute arthritis stage group(n=38),the intermittent arthritis stage group(n=26)and the chronic arthritis stage group(n=32).Another 35 healthy individuals who underwent physical examinations at the same time at the medical examination center of our hospital were selected as the control group.The levels of NALP3 inflammasome and peripheral bloodγδT cells in each group were observed.The clinical indicators of GA patients in each group were analyzed,including the levels of serum uric acid,serum creatinine,total cholesterol,triglyceride,serum C-reactive protein(CRP)and white blood cell count(WBC).Pearson correlation was used to analyze the relationship between peripheral blood gamma-delta T cells and their subtypes,NALP3 inflammasome and clinical indexes in patients with acute arthritis.Results There was no statistically significant difference in the comparison of NALP3 andγδT1 cells in each group(P>0.05);there were statistically significant differences in Caspase-1,ASC,γδTcells,andγδT2 cells among the groups(P<0.05).Among them,the levels of Caspase-1 in the acute arthritis stage group,intermittent stage group,and chronic arthritis stage group were higher than those in the control group,and the proportion ofγδT cells andγδT2 cells was lower than that in the control group,the higher the severity of the disease,the higher the Caspase-1 level,and the lower the proportion ofγδT cells andγδT2 cells;the ASC levels in the acute arthritis stage group,intermittent stage group,and chronic arthritis stage group were higher than those in the control group,but the acute arthritis stage group was lower than those in the intermittent stage group and chronic arthritis stage group,the differences were statistically significant(P<0.05).There were no significant differences in no significant difference in total cholesterol,triglyceride and CRP among all groups(P>0.05).There were statistically significant differences in the levels of blood uric acid,WBC,and creatinine in each group,and the differences were statistically significant(P<0.05).Among them,the levels of blood uric acid,WBC,and creatinine in the acute arthritis stage group,intermittent stage group,and chronic arthritis stage group were higher than those in the control group,and the differences were statistically significant(P<0.05).Moreover,the higher the severity of the disease,the higher the levels of blood uric acid,WBC,and creatinine.Correlation analysis showed that the proportion ofγδT cells in lymphocytes and the proportion ofγδT1 cells inγδT cells had no significant correlation with serum uric acid,serum creatinine,total cholesterol,triglyceride,WBC and CRP.The proportion ofγδT2 inγδT cells was negatively correlated with triglyceride and WBC(P<0.05).Correlation analysis showed that there was no significant correlation between NALP3 mRNA expression and serum creatinine,total cholesterol,triglyceride and WBC.It was positively correlated with BUA and CRP(P<0.05).Conclusion NALP3 inflammasomes and peripheral bloodγδT cells participate in the development of GA.Caspase-1,γδT cells andγδT2 cells can be used as markers of acute inflammation in gout,while ASC cannot be used as markers of acute inflammation in gout.Meanwhile,the proportion ofγδT2 inγδT cells is negatively correlated with triglyceride and WBC.The expression of NALP3 mRNA is positively correlated with serum uric acid and CRP,which provides a reference for clinical evaluation and treatment.