痛風(fēng)性關(guān)節(jié)炎患者血清及組織中IL-17水平研究
發(fā)布時間：2019-02-22 09:59
【摘要】：背景：隨著生活水平的提高,高尿酸血癥和痛風(fēng)的患病率呈逐年上升的趨勢。痛風(fēng)也得到了越來越多的關(guān)注與研究。目前的研究認(rèn)為痛風(fēng)急性發(fā)作是尿酸鹽晶體變化誘發(fā)的一個急性炎癥過程,經(jīng)過吞噬細(xì)胞、中性粒細(xì)胞的參與,誘導(dǎo)產(chǎn)生一系列炎癥反應(yīng)。在整個炎癥反應(yīng)過程中,IL-1β、TNF-α、IL-6、TGF-β、中性粒細(xì)胞趨化因子(CXCL1)等多種炎癥因子均參與到其中。而IL-17與多種自身免疫病的發(fā)病有關(guān),隨著IL-17在類風(fēng)濕性關(guān)節(jié)炎中的深入研究,證實了IL-17在導(dǎo)致關(guān)節(jié)炎癥改變和骨質(zhì)破壞中發(fā)揮著明確的作用。IL-17主要通過介導(dǎo)滑膜炎癥、軟骨破壞、骨侵蝕這三方面發(fā)揮作用。同樣作為一種炎癥性關(guān)節(jié)炎,IL-17是否也參與了痛風(fēng)患者關(guān)節(jié)炎的炎癥反應(yīng),并在其中發(fā)揮了不可忽視的作用?為了探討這一問題,我們做了以下研究。目的：通過測定IL-17在痛風(fēng)患者中的表達(dá)水平,研究痛風(fēng)患者IL-17是否有異常增高的表達(dá)。并探索可能影響痛風(fēng)患者IL-17水平的臨床特點(diǎn)以及IL-17在痛風(fēng)中可能的作用。方法：1.通過篩選2014年9月-2015年4月北京協(xié)和醫(yī)院痛風(fēng)門診的痛風(fēng)患者,痛風(fēng)風(fēng)診斷符合1977年美國風(fēng)濕病學(xué)會(American College of Rheumatology, ACR)分類標(biāo)準(zhǔn)。收集患者基本資料、臨床癥狀、生化指標(biāo)并留取血清標(biāo)本。采用Elisa檢測痛風(fēng)患者血清IL-17水平,比較痛風(fēng)患者與對照組IL-17表達(dá)水平差異,分析不同水平IL-17痛風(fēng)患者臨床癥狀及血生化指標(biāo)的差異,通過亞組分析和單因素相關(guān)性分析影響痛風(fēng)患者IL-17表達(dá)水平的因素。2.通過留取北京協(xié)和醫(yī)院骨科2014年1月-2015年5月因痛風(fēng)性關(guān)節(jié)炎行關(guān)節(jié)手術(shù)的患者的關(guān)節(jié)滑膜組織標(biāo)本(盡可能靠近痛風(fēng)石或病變處滑膜組織),做石蠟病理切片,后行免疫組化染色。所有研究對象完成基本資料及臨床資料登記。觀察Th17細(xì)胞在痛風(fēng)患者關(guān)節(jié)滑膜組織中是否存在,并分析Th17陽性患者臨床特征的特點(diǎn)。結(jié)果：1.痛風(fēng)組患者IL-17檢出比例為30.6%(11/36),OA組患者IL-17檢出比例為0%(0/20),經(jīng)四格表X2檢驗計算得p=0.006,兩組病人IL-17檢出率上存在顯著差異。相比IL-17陰性組患者,IL-17陽性組痛風(fēng)患者患者病程更長長,受累關(guān)節(jié)數(shù)目更多,IL-6水平更高,并出現(xiàn)顯著性差異；IL-6的水平在不同病程、不同發(fā)作頻率以及不同hsCRP水平的患者之間有顯著性差異。各分組均沒有發(fā)現(xiàn)TNF-a表達(dá)水平有顯著性差異。2.15名痛風(fēng)患者中有5名患者的關(guān)節(jié)組織切片IL-17免疫組化染色結(jié)果為陽性,陽性率為33.3%：5名OA患者中沒有IL-17免疫組化染色結(jié)果為陽性的患者,陽性率為0%(0/5)。結(jié)論：1.痛風(fēng)患者血清IL-17高表達(dá)。2.IL-17陽性組痛風(fēng)患者發(fā)病病程更長,受累關(guān)節(jié)數(shù)目更多,IL-6水平更高。3.痛風(fēng)患者發(fā)病病程越長,發(fā)作頻率越多,hsCRP呈陽性,血清IL-6水平越高。4.痛風(fēng)患者關(guān)節(jié)組織中存在能分泌IL-17的細(xì)胞。
[Abstract]:Background: with the improvement of living standard, the prevalence of hyperuricemia and gout is increasing year by year. Gout also gets more and more attention and research. It is believed that acute attack of gout is an acute inflammatory process induced by the changes of uric acid crystals, and a series of inflammatory reactions are induced by phagocytes and neutrophils. IL-1 尾, TNF- 偽, IL-6,TGF- 尾, neutrophil chemokine (CXCL1) and other inflammatory factors are involved in the whole process of inflammatory reaction. IL-17 is associated with many autoimmune diseases, and with the further study of IL-17 in rheumatoid arthritis, IL-17 plays a role in mediating synovitis cartilage destruction and bone erosion. As an inflammatory arthritis, is IL-17 also involved in the inflammatory response of gout patients and plays an important role in it? In order to explore this problem, we have done the following research. Aim: to determine the expression of IL-17 in patients with gout. To explore the clinical characteristics of IL-17 in patients with gout and the possible role of IL-17 in gout. Methods: 1. Gout patients in outpatient department of Beijing Union Hospital from September 2014 to April 2015 were screened. The diagnosis of gout met the (American College of Rheumatology, ACR) classification standard of American Rheumatology Society in 1977. Collect the basic data, clinical symptoms, biochemical indicators and serum samples. The serum IL-17 level of gout patients was measured by Elisa, and the difference of IL-17 expression between gout patients and control group was compared, and the differences of clinical symptoms and blood biochemical indexes in patients with gout were analyzed. Subgroup analysis and univariate correlation analysis were used to analyze the factors influencing the expression of IL-17 in patients with gout. 2. 2. Specimens of synovial tissue (as close as possible to gout stone or synovial tissue) of patients undergoing joint surgery for gouty arthritis from January 2014 to May 2015 were taken from the Orthopaedics Department of Peking Union Hospital for paraffin sections. Then immunohistochemical staining was performed. All subjects completed the registration of basic and clinical data. To observe the presence of Th17 cells in synovial tissue of gout patients and to analyze the clinical features of Th17 positive patients. Results: 1. The detection rate of IL-17 in gout group was 30.6% (0 / 20) in 11 / 36), OA group (0 / 20), and p0. 006 was calculated by four grid table X2 test. There was a significant difference in the detection rate of IL-17 between the two groups. Compared with the patients with negative IL-17, the patients with gout in IL-17 positive group had longer course of disease, more involved joints and higher IL-6 level, and there were significant differences. There were significant differences in IL-6 levels among patients with different course of disease, different seizure frequency and different hsCRP levels. There was no significant difference in the expression of TNF-a in all groups. 2.The expression of IL-17 was positive in 5 out of 15 patients with gout. The positive rate was 33. 3% (0 / 5) in 5 OA patients who had no positive results of IL-17 immunohistochemical staining and the positive rate was 0% (0 / 5). Conclusion: 1. High expression of serum IL-17 in patients with gout. The disease course of gout patients with positive 2.IL-17 was longer, the number of affected joints was more, and the level of IL-6 was higher. 3. 3%. In gout patients, the longer the course of disease, the more frequent attacks, hsCRP positive, the higher the level of serum IL-6. 4. 4. There are cells in the joints of gout patients that secrete IL-17.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R589.7
本文編號：2428106
[Abstract]:Background: with the improvement of living standard, the prevalence of hyperuricemia and gout is increasing year by year. Gout also gets more and more attention and research. It is believed that acute attack of gout is an acute inflammatory process induced by the changes of uric acid crystals, and a series of inflammatory reactions are induced by phagocytes and neutrophils. IL-1 尾, TNF- 偽, IL-6,TGF- 尾, neutrophil chemokine (CXCL1) and other inflammatory factors are involved in the whole process of inflammatory reaction. IL-17 is associated with many autoimmune diseases, and with the further study of IL-17 in rheumatoid arthritis, IL-17 plays a role in mediating synovitis cartilage destruction and bone erosion. As an inflammatory arthritis, is IL-17 also involved in the inflammatory response of gout patients and plays an important role in it? In order to explore this problem, we have done the following research. Aim: to determine the expression of IL-17 in patients with gout. To explore the clinical characteristics of IL-17 in patients with gout and the possible role of IL-17 in gout. Methods: 1. Gout patients in outpatient department of Beijing Union Hospital from September 2014 to April 2015 were screened. The diagnosis of gout met the (American College of Rheumatology, ACR) classification standard of American Rheumatology Society in 1977. Collect the basic data, clinical symptoms, biochemical indicators and serum samples. The serum IL-17 level of gout patients was measured by Elisa, and the difference of IL-17 expression between gout patients and control group was compared, and the differences of clinical symptoms and blood biochemical indexes in patients with gout were analyzed. Subgroup analysis and univariate correlation analysis were used to analyze the factors influencing the expression of IL-17 in patients with gout. 2. 2. Specimens of synovial tissue (as close as possible to gout stone or synovial tissue) of patients undergoing joint surgery for gouty arthritis from January 2014 to May 2015 were taken from the Orthopaedics Department of Peking Union Hospital for paraffin sections. Then immunohistochemical staining was performed. All subjects completed the registration of basic and clinical data. To observe the presence of Th17 cells in synovial tissue of gout patients and to analyze the clinical features of Th17 positive patients. Results: 1. The detection rate of IL-17 in gout group was 30.6% (0 / 20) in 11 / 36), OA group (0 / 20), and p0. 006 was calculated by four grid table X2 test. There was a significant difference in the detection rate of IL-17 between the two groups. Compared with the patients with negative IL-17, the patients with gout in IL-17 positive group had longer course of disease, more involved joints and higher IL-6 level, and there were significant differences. There were significant differences in IL-6 levels among patients with different course of disease, different seizure frequency and different hsCRP levels. There was no significant difference in the expression of TNF-a in all groups. 2.The expression of IL-17 was positive in 5 out of 15 patients with gout. The positive rate was 33. 3% (0 / 5) in 5 OA patients who had no positive results of IL-17 immunohistochemical staining and the positive rate was 0% (0 / 5). Conclusion: 1. High expression of serum IL-17 in patients with gout. The disease course of gout patients with positive 2.IL-17 was longer, the number of affected joints was more, and the level of IL-6 was higher. 3. 3%. In gout patients, the longer the course of disease, the more frequent attacks, hsCRP positive, the higher the level of serum IL-6. 4. 4. There are cells in the joints of gout patients that secrete IL-17.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R589.7
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相關(guān)期刊論文 前2條
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2 曾慶馀,王慶文,陳韌,肖征宇,黃少弼,許敬才;Primary gout in Shantou: a clinical and epidemiological study[J];Chinese Medical Journal;2003年01期
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