类风湿关节炎患者早发动脉硬化及心血管病变的临床研究

目的 通过颈部及心脏彩色多普勒超声检查了解类风湿关节炎(RA)患者早发动脉硬化及心血管病变的发生情况,并分析其与炎症因子的关系.方法 收集无心血管疾病史及无明显胸闷心悸等临床表现的RA患者69例及正常对照76例,详细记录RA患者的症状体征及实验室指标.应用彩色多普勒超声探查心脏和颈动脉,检测颈动脉最大内膜中层厚度(M-...     

类风湿关节炎患者血清巨噬细胞移动抑制因子白细胞介素-17及-23表达与合并动脉粥样硬化的相关性研究

目的 通过颈部彩色多普勒超声检测类风湿关节炎(RA)患者合并动脉粥样硬化情况,检测血清巨噬细胞移动抑制因子(MIF)及白细胞介素(IL)-17、IL-23水平,分析它们之间的相关性及在RA致动脉粥样硬化中的作用.方法 收集69例RA患者,根据颈部血管彩色多普勒超声结果,分为合并动脉粥样硬化组36例及无动脉粥样硬化组33例,并设64名健康者为健康对照组.采用酶联免疫吸附试 验(ELISA)法检测3组血清MIF、IL-17及IL-23水平.采用t检验、方差分析进行统计分析,相关性分析采用Pearson相关分析和Logistic回归分析.结果 合并动脉粥样硬化组MIF水平明显高于无动脉粥样硬化组及健康对照组(3组分别为15.2±1.7,13.8±2.2,8.0±2.9,P<0.05),且与颈动脉内膜中层厚度(IMT)值(r=0.271,P=0.036)、斑块大小(r=0.291,P=0.024)、IL-17(r=0.328,P=0.007)及IL-23(r=0.316,P=0.010)水平呈正相关;合并动脉粥样硬化组IL-17和IL-23水平高于健康对照组(2.8±2.0和2.0±0.8,449±174和341±113),但与无动脉粥样硬化组比较差异无统计学意义.Logistic回归分析显示RA患者MIF水平与动脉粥样硬化的发生呈正相关.结论 RA合并动脉粥样硬化患者血清MIF水平显著升高,且与IL-17、IL-23表达密切相关,血清MIF水平升高可作为RA患者发生动脉粥样硬化的预测指标.

Abstract：

objective To detect the serum macrophage migration inhibitory factor(MIF)and interlbukin (IL)-17,IL-23 levels in rheumatoid arthritis patients with atherosclerosis and to analyze the association between them and their role in the pathogenesis of atherosclerosis in rheumatoid arthritis patients.Methods Total of 69 patients with RA were divided into atherosclerosis group(AS group)and those without atherosclerosis group(NAS group)according to neck vascular ultrasonography.Sixty-four healthy controls(the control group)were also enrolled into this study.MIF and IL-17,IL-23 levels were determined bv ELISA assay.The t test of two independent-samples and One-way ANOVA were used to compare the levels of MIF.IL-17 and IL-23 in different groups of patients and healthy individuals.The correlation between diffrent paramenters was assesed by Pearson's coefficient of correlation and Logistic regression.Results The serum MIF level in the AS group was significantly higher than that in the NAS group and healthy controls(15.2±1.7,13.8±2.2,8.0±2.9,P<0.05),and there were significant correlations between the serum MIF concentration,carotid intima-media thickness(IMT)(r=0.271,P=0.036).the size of atherosclerotic plaques(r=0.291,P=0.024),the serum level of IL-17(r=0.328,P=0.007)and IL-23(r=0.316,p=0.010).The serum IL-17 and IL-23 level in the AS group was higher than healthy controls(2.8±2.0 vs 2.0±0.8,449±174 vs 341±113),while there were no significant differences between AS group and NAS group.The serum MIF level in RA patients was positively correlated with atherosclerosis according to Logistic regression analysis.Conclusion The serum MIF level in RA patients with AS is significantly higher than that in NAS group and healthy controls,and it may be related with the serum level of IL-17 and IL-23.The elevated serum MIF level may be a predictor for atherosclerosis in patients with rheumatoid arthritis.     

Th17细胞/调节性T细胞平衡与类风湿关节炎

类风湿关节炎(rheumatoid arthritis,RA)是一种以慢性侵蚀性关节炎为主要表现的自身免疫性疾病,发病机制尚不明确,Th17细胞/调节性T细胞平衡失调可能参与其异常自身免疫过程.本文就Th17细胞/调节性T细胞平衡在RA发病机制中的作用作一综述.     

类风湿关节炎患者血清激活素A、鸢尾素水平与疾病活动度、骨密度和骨骼肌质量的相关性研究

目的 分析类风湿关节炎(RA)患者血清激活素A、鸢尾素水平与疾病活动度、骨密度和骨骼肌质量的相关性.方法 选择2018年3月—2021年1月安徽医科大学第三附属医院风湿免疫科收治RA患者90例(RA组),根据28个关节疾病活动度(DAS28)评分分为低度亚组(2.6～3.2分,31例)、中度亚组(3.3～5.1分,37...     

类风湿关节炎患者Th17/Treg相关细胞因子水平变化及其临床意义的研究

目的:通过检测类风湿关节炎(RA)患者血清及关节液中Th17与Treg细胞相关细胞因子IL-17、IL-6、IL-23、TGF-β的水平,探讨其在RA发病机制中的作用及其临床意义.方法:采用酶联免疫吸附法(ELISA)测定45名RA患者和23名正常对照者血清及8名RA患者关节液中IL-17、IL-6、IL-23和TGF-β的水平,分析其与临床及实验室指标的关系.结果:RA患者血清中IL-6、IL-17、IL-23水平明显高于正常对照组,关节液中IL-17水平较血清中明显升高.血清IL-17及IL-23水平与关节肿胀数、DAS28评分等病情活动指标正相关.严重骨破坏组血清IL-17和IL-6水平明显升高,单因素回归分析显示血清IL-17水平对骨侵蚀有显著影响.结论:RA患者Th17与Treg细胞相关细胞因子IL-17、L-6,IL-23水平明显升高,与病情活动及骨质破坏相关,可能参与了RA的发病和病情进展.     

类风湿关节炎的诊治进展

近十余年来类风湿关节炎(rheumatoid arthri-tis,RA)从遗传基因、发病机制到临床诊断治疗方面都取得了飞跃的发展,极大的改善了,患者的顶后,被称为"类风湿关节炎跨越的十年".但在国内发展尚不平衡.刘栩等报道[1]:RA患者在风湿免疫专科首次就诊比例低,就诊及确诊均存在时间延误,从患者出现症状到确诊RA的中位时间为6个月;约半数以上的患者未接受正规的DMARDs治疗,在非专科RA的非正规化诊治现象仍很常见等.     

类风湿关节炎患者外周血Th17细胞/调节性T细胞变化及其临床意义

目的 通过检测类风湿关节炎(RA)患者外周血,Th17细胞和调节性T细胞的变化,探讨其在RA发病机制中的作用及其临床意义.方法 采用流式细胞术(FCM)检测57例RA患者和32名健康对照者外周血单个核细胞(PBMCs)中IL-17+CD4+T细胞(Th17细胞)与Foxp3+CD25+CD4+T细胞(调节性T细胞)占CD4+T细胞的百分比,分析其与RA临床及实验室指标的关系.统计学处理采用t检验和方差分析,相关分析采用Pearson直线相关分析.结果 RA组Th17细胞占CD4+T细胞的百分率较健康对照组明显升高[(4.2±2.2)%和(2.3±1.4)%,P=0.000],调节性T细胞降低[(3.9±1.6)%和(7.0±2.2)%,P=0.000],Th17细胞/涮节性T细胞比值显著升高(1.15±0.62和O.34±0.17,P=0.000).RA早期组与非早期组外周血Thl7细胞、调节性T细胞及,Th17调节性T细胞比值比较,差异无统计学意义(P均>0.05).相关性分析显示RA患者Th17细胞及Th17细胞/调节性T细胞比值与关节压痛数、患者疼痛模拟视觉评分(VAS)、RA28关节疾病活动评分(DAS)28评分等病情活动指标呈正相关(P均<0.05),而调节性T细胞与上述病情活动指标无明显相关性(P均>0.05).单因素回归分析显示Th17细胞、Th17细胞/调节性T细胞比值、DAS28评分及病程对RA患者骨侵蚀有显著影响(P均<0.05).经抗风湿药物治疗后,RA患者Th17细胞阙节性T细胞比值降低.结论 RA患者Th17细胞明显增多,调节性T细胞减少,Th17细胞/调节性T细胞比例明显增高.可能是RA发病的重要原因,通过抗风湿药物治疗可调节Th17细胞/调节性T细胞亚群平衡.

Abstract：

Objective To analyze the level of Th17 and Treg cells in the peripheral blood of patients with rheumatoid arthritis(RA),and to investigate its role in the pathogenesis of RA and the clinical significance.Methods Flow cytometry(FCM)was used to analyze the ratio of interleukin(IL)-17+CD4+T (Thl7)cells and Foxp3+CD25+CD4+T(Treg)cells in CD4+T cells from the peripheral blood of 57 RA patients and 32 normal controls.T-test and Chi-square test were used for inter-group comparison and Pearson's linear analysis was used for correlation analysis.Resuits Compared with normal controls.the level of both IL-17+CD4+T cells and the ratio of Th17/Treg in RA patients increased significantly.while the level of Foxp3+CD4+CD25+T cells decreased markedly[(4.2±2.2)%vs(2.3±1.4)%,P=0.000;1.15±0.62 I)5 0.34±0.17,P=0.000;(3.9±1.6)%vs(7.0±2.2)%,P=0.000].Compared with early RA(persistent for 2 years or less)patients,the levels of Th17,Treg and the ratio of Th17/Treg in chronic RA(duration for more than 2 years)patients didn't markedly changed(P>0.05).The level of Th17 cells and the ratio of Th17/Treg was directlycorrelated with disease activity parameter (including tender ioint counts,visual analog seale of patients,disease activitv score in 28 joints,etc).Regression analysis discovered that risk factors of bone erosion were the level of Th17 cells,the ratio of Th17/Treg,disease activity score in 28 joints and disease duration.Antirheumatic drugs could decreascthe ratio of Th 17/Treg.Conclusions Treg cells is decreased in RA patients while Th7 cells is increased in patients with RA.Th17/Treg ratio goes up significantly as well.Change of T celt subsets,especially Th17 and Treg cells are important for the pathogenesis of RA.Th17 and Treg cells could aggrevate disease activity and bone destruction throughout the whole disease process.Anti-rheumatic medications is effective by regulating Th17/Treg subset balance.