重症溃疡性结肠炎患者外周血中髓样树突状细胞和IL-17A表达及预后研究

目的 探讨重症活动期溃疡性结肠炎(ulcerative colitis,UC)患者外周血单个核细胞(PBMC)中髓样树突状细胞(myeloid dendritic cell,MDC)比例和IL-17A水平及与预后关系。 方法 选取2016年1月—2019年3月温州市中西医结合医院收治的重症活动期UC患者90例作为研究对象,根据其预后情况分为预后良好组(49例)、预后不良组(41例)。利用流式细胞术检测PBMC中MDC,酶联免疫吸附试验(ELISA)检测血浆IL-17A水平。 结果 治疗后2组PBMC中MDC比例和血浆IL-17A水平低于治疗前(均P<0.001);治疗前后预后良好组PBMC中MDC比例分别为(0.48±0.15)%、(0.29±0.09)%,低于预后不良组的(0.56±0.17)%、(0.44±0.13)%(均P<0.05);血浆IL-17A水平分别为(12.97±4.24)ng/L、(9.05±2.96)ng/L,低于预后不良组的(16.02±5.13)ng/L、(11.88±3.90)ng/L(均P<0.05)。重症活动期UC患者PBMC中MDC比例与血浆IL-17A水平呈正相关(r=0.692,P<0.001)。入院时腹泻≥10次/d、MDC及IL-17A是影响重症活动期UC患者不良预后的独立危险因素(均P<0.05)。PBMC中MDC比例联合血浆IL-17A水平预测重症活动期UC患者不良预后的AUC为0.943,预测效果优于单独检测。 结论 PBMC中MDC比例和血浆IL-17A水平升高可作为评估重症活动期UC患者不良预后的潜在标记物。 

Study on the expressions of MDC and IL-17A in peripheral blood of patients with severe ulcerative colitis and prognosis

Objective To investigate the changes of myeloid dendritic cells(MDC) ratio and interleukin-17 A(IL-17 A) expression in peripheral blood mononuclear cells(PBMC) of patients with severe active ulcerative colitis(UC), and to analyze their relationship with prognosis. Methods Total 90 patients with severe active UC from January 2016 to March 2019 in the Wenzhou Integrated Traditional Chinese and Western Medicine Hospital were divided into good prognosis group(n=49) and poor prognosis group(n=41). MDC in PBMC was detected by flow cytometry, and IL-17 A expression in plasma was detected by enzyme-linked immunosorbent assay(ELISA). Results After treatment, the proportion of MDC in PBMC and the expression of IL-17 A in plasma of the two groups were significantly lower than those before treatment(P ≤ 0.001). The proportion of MDC in PBMC of patients with good prognosis before and after treatment was(0.48±0.15)%,(0.29±0.09)%, which were significantly lower than those of patients with poor prognosis(0.56±0.17)%,(0.44±0.13)%(all P<0.05). The levels of IL-17 A in plasma were(12.97±4.24) ng/L,(9.05±2.96) ng/L, which were significantly lower than those in the poor prognosis group(16.02±5.13) ng/L,(11.88±3.90) ng/L(all P<0.05). The proportion of MDC in PBMC was positively correlated with the level of plasma IL-17 A expression in patients with severe active UC(r=0.692, P<0.001). Diarrhea(≥ 10 times per day) at admission, MDC ratio and IL-17 A were independent risk factors for adverse prognosis of UC patients in severe active stage after treatment(all P<0.05). The AUC of MDC ratio in PBMC combined with plasma IL-17 A expression predicting the adverse prognosis of severe UC patients in active stage was 0.943, the prediction effect was better than single detection. Conclusion Increased MDC ratio and plasma IL-17 A expression in PBMC can be used as potential markers for evaluating the adverse prognosis of severe UC patients in active stage.