【摘要】：目的:檢測類風濕關(guān)節(jié)炎(RA)患者外周血CD19+CD24hiCD38hi、CD19+CD24hiCD27+調(diào)節(jié)性B細胞(Bregs)占CD19+B細胞的百分率,探討外周血CD19+CD24hiCD38hiBregs、CD19+CD24hiCD27+Bregs頻率與RA臨床指標的相關(guān)性,明確治療前后CD19+CD24hiCD38hiBregs的變化情況。方法:以CD19+CD24hiCD38hi作為Bregs標記,流式細胞儀三色熒光抗體標記法檢測95例RA患者和40例健康對照者(HC)外周血CD24hiCD38hi細胞占CD19+B淋巴細胞的百分率,觀察不同嚴重程度患者的CD19+CD24hiCD38hiBregs比例變化趨勢,并研究其與RA患者疾病活動度指標(DAS28評分)、血沉(ESR)、超敏C反應(yīng)蛋白(hc CRP)、類風濕因子(RF)、晨僵時間、視覺模擬評分(VAS評分)、關(guān)節(jié)腫脹數(shù)、關(guān)節(jié)壓痛數(shù)以及其他相關(guān)性指標如年齡、病程、關(guān)節(jié)功能分級、日常生活能力(HAQ)評分等之間的相關(guān)性。隨訪其中25例RA患者,對比治療6個月后較基線時外周血CD19+CD24hiCD38hiBregs的變化情況。另選57例RA患者和21例健康對照者,以CD19+CD24hiCD27+作為Bregs標記,通過流式細胞儀三色熒光抗體標記法檢測外周血CD24hiCD27+細胞占CD19+B淋巴細胞的比例,結(jié)合臨床資料進行相關(guān)性分析。結(jié)果:RA組CD24hiCD38hi細胞占CD19+B淋巴細胞的比例(6.48±4.98)%低于HC組(7.23±3.40)%,但兩組間差異未達到統(tǒng)計學(xué)意義(p0.05)。其中DAS283.2組(n=19)、3.2≤DAS28≤5.1組(n=45)、DAS285.1組(n=31)CD24hiCD38hi細胞占CD19+B細胞的比例分別為(6.09±4.35)%、(6.15±5.28)%、(7.16±4.94)%,CD19+CD24hiCD38hiBregs的平均數(shù)量隨疾病活動度的增高而增加。相關(guān)性分析發(fā)現(xiàn)RA患者CD19+CD24hiCD38hiBregs比例與晨僵時間呈正相關(guān)(r=0.227,p=0.027),與年齡、抗CCP抗體滴度水平均呈負相關(guān)(r=-0.234,p=0.022;r=-0.218,p=0.036)。外周血CD19+CD24hiCD38hiBregs的變化與治療情況明顯相關(guān)。病情無改善者(持續(xù)中重度活動,n=12)Bregs細胞數(shù)量增加,病情緩解者(由中重度活動到輕度活動或完全臨床緩解,n=8)Bregs細胞數(shù)量下降,病情穩(wěn)定者(持續(xù)處于輕度活動或病情完全緩解,n=5)Bregs細胞數(shù)量下降。RA組CD24hiCD27+細胞占CD19+B淋巴細胞的比例(12.36±7.08)%高于HC組(7.67±3.54)%,兩組差異無統(tǒng)計學(xué)意義(p0.05)。RA組中DAS283.2組(n=25)和DAS28≥3.2組(n=32)間外周血CD24hiCD27+B細胞占CD19+B淋巴細胞的百分比分別為(9.07±6.27)%和(7.67±3.54)%,兩組間差異無統(tǒng)計學(xué)意義(p0.05)。相關(guān)性分析發(fā)現(xiàn)RA患者CD19+CD24hiCD27+Bregs比例與年齡、病程、ESR、hs CRP、RF、抗CCP抗體、DAS28評分等均無相關(guān)性。結(jié)論:RA組外周血CD24hiCD38hiB細胞、CD24hiCD27+B細胞占CD19+B淋巴細胞的百分率與對照組間比例的差異情況未達到統(tǒng)計學(xué)差異,在RA患者中CD19+CD24hiCD38hiBregs隨著病情活動性升高其數(shù)量反應(yīng)性增加,隨著治療好轉(zhuǎn)其數(shù)量隨之降低,提示CD19+CD24hiCD38hiBregs在RA的發(fā)病及炎癥活動中可能起一定作用。
[Abstract]:Objective: to detect the percentage of CD19 CD24hiCD38hi,CD19 CD24hiCD27 regulatory B cell (Bregs) in CD19 B cells in patients with rheumatoid arthritis (RA), and to explore the correlation between the frequency of CD19 CD24hiCD38hiBregs,CD19 CD24hiCD27 Bregs in peripheral blood and the clinical indexes of RA. The changes of CD19 CD24hiCD38hiBregs before and after treatment were determined. Methods: the percentage of (HC) peripheral blood CD24hiCD38hi cells in CD19 B lymphocytes in 95 patients with RA and 40 healthy controls was detected by flow cytometry with CD19 CD24hiCD38hi as Bregs marker. The change trend of CD19 CD24hiCD38hiBregs ratio in patients with different severity was observed, and the index of disease activity (DAS28 score) and erythrocyte sedimentation rate (ESR),) high sensitive C-reactive protein (hc CRP), rheumatoid factor (RF), morning stiffness time were studied. Visual simulation score (VAS score), number of joint swelling, number of joint tenderness and other related indexes such as age, course of disease, joint function grade, ability of daily living (HAQ) score and so on. Twenty-five patients with RA were followed up and the changes of CD19 CD24hiCD38hiBregs in peripheral blood after 6 months of treatment were compared with those at baseline. The proportion of peripheral blood CD24hiCD27 cells to CD19 B lymphocytes was detected by flow cytometry in 57 patients with RA and 21 healthy controls using CD19 CD24hiCD27 as Bregs marker. The correlation analysis was carried out with clinical data. Results: the proportion of CD24hiCD38hi cells in CD19 B lymphocytes in RA group (6.48 鹵4.98)% was lower than that in HC group (7.23 鹵3.40)%, but there was no significant difference between the two groups (p0.05). In DAS283.2 group (n 鈮，

本文編號：2481080