氨甲喋呤对类风湿性关节炎患者外周血单个核细胞产生细胞因子的影响

目的研究氨甲喋呤（ＭＴＸ）对类风湿性关节炎（ＲＡ）患者外周血单个核细胞（ＰＢＭＣ）产生细胞因子的影响。方法采用ＥＬＩＳＡ双抗夹心法，观察ＲＡ患者ＴＮＦ－α、ＩＬ－６的自发分泌及ＭＴＸ和ＬＰＳ的影响，以及ＭＴＸ和ＰＨＡ对ＩＬ－１０和ＩＦＮ－γ产生的影响。结果低浓度ＭＴＸ（５ｍｇ·Ｌ－１）有抑制ＲＡ患者ＰＢＭＣ自发分泌ＩＬ－６的作用，并对ＬＰＳ（１０ｍｇ·Ｌ－１）诱导ＩＬ－６的产生具有抑制作用，对ＴＮＦ－α的自发分泌及ＬＰＳ促分泌作用无明显影响；而高浓度ＭＴＸ（１５ｍｇ·Ｌ－１）对ＴＮＦ－α、ＩＬ－６和ＩＮＦ－γ均具有抑制作用；并能促进ＰＨＡ（１０ｍｇ·Ｌ－１）诱导ＩＬ－１０的产生；使ＩＬ－１０／ＩＮＦ－γ的比率上升。结论ＭＴＸ通过调节细胞因子网络（增高Ｔｈ２型细胞产生的细胞因子和降低Ｔｈ１型细胞产生的细胞因子）来发挥免疫调节作用和抑制炎症反应，这可能是其对ＲＡ产生治疗作用机制之一

Effect of methotrexate on cytokins production by peripheral blood mononuclear cells of patients with rheumatoid arthritis

AIM To study mechanism of action of methotrexate in treatment of patients with rheumatoid arthritis. METHODS MTX of different concentrations(5 mg·L -1 ,15 mg·L -1 ) were added to the cultures of PBMC either in medium alone (spontaneous) or in the presence of 10 μg of LPS or PHA. To observe the in vitro action of MTX on spontaneous and LPS stimulated TNF α and IL 6 & PHA stimulated INF γ and IL 10 production by PBMC of RA patients with ELISA.RESULTS MTX at higher dose of 15 mg·L -1 , inhibited spontaneous and LPS stimulated TNF α and IL 6 productin & PHA stimulated INF γ by PBMC of RA patients;increased PHA stimulated IL 10 production; significantly increased the mean IL 10∶ INF γ ratio. MTX at lower dose of 5 mg·L -1 , supressed spontaneous and LPS stimulated IL 6 productin but did not influence spontaneous and LPS stimulated TNF α production. CONCLUSION In vitro modulation of the cytokine network by MTX, increasing Th2 cytokines and decreasing Th1 cytokines, could explain its antiinflammatory and immunoregulatory actions in vivo during the treatment of RA.