【摘要】：目的:類風(fēng)濕關(guān)節(jié)炎(rheumatoid arthritis,RA)是一種慢性、進(jìn)展性、炎癥性疾病,以對稱性滑膜炎癥和骨侵蝕為特征。白細(xì)胞介素-28B(IL-28B)是干擾素λ家族(也被稱為III型干擾素)的一個成員,它已經(jīng)在許多疾病中被研究過,然而,有關(guān)RA患者中IL-28B的研究尚無報道。而白細(xì)胞介素-29(IL-29),干擾素λ家族另一個成員,與IL-28B氨基酸同源性為81%,在RA患者血清、滑膜中過度表達(dá),并能促進(jìn)促炎性細(xì)胞因子白細(xì)胞介素-6(IL-6)和白細(xì)胞介素-8(IL-8)m RNA在滑膜成纖維細(xì)胞的表達(dá)。本文旨在探討在RA患者應(yīng)用慢作用抗風(fēng)濕藥(DMARDs)治療前、治療后1個月、治療后3個月、治療后6個月血清IL-28B表達(dá)水平及其與患者臨床特征、實(shí)驗(yàn)室指標(biāo)及影像學(xué)評估的相關(guān)性,進(jìn)而探討其在RA診治中的作用。方法:選取80例符合1987年美國風(fēng)濕病學(xué)會(ACR)分類標(biāo)準(zhǔn)或ACR/歐洲抗風(fēng)濕聯(lián)盟(EULAR)2010年分類標(biāo)準(zhǔn)的RA患者,并選取與之年齡、性別無明顯差異的80名健康體檢者作為對照組。用酶聯(lián)免疫吸附法(ELISA)測定80例RA患者在DMARDs治療前、治療后1個月、治療后3個月、治療后6個月及80名健康體檢者血清IL-28B水平。影像學(xué)評估使用Sharp評分(TSS)。收集患者臨床數(shù)據(jù),包括:年齡、性別、病程、晨僵時間、關(guān)節(jié)休息痛、健康評估問卷(HAQ)、醫(yī)生疼痛評估、患者疼痛評估、關(guān)節(jié)功能分級、關(guān)節(jié)壓痛數(shù)、關(guān)節(jié)腫脹數(shù)、紅細(xì)胞沉降率(ESR)、C反應(yīng)蛋白(CRP)、血小板、類風(fēng)濕因子(RF)、抗環(huán)瓜氨酸多肽(CCP)抗體、免疫球蛋白A(Ig-A)、免疫球蛋白G(Ig-G)、免疫球蛋白M(Ig-M);計(jì)算疾病活動評分DAS28-ESR和DAS28-CRP。結(jié)果:(1)RA患者血清IL-28B水平明顯低于健康對照組(p=0.020)。(2)RA患者血清IL-28B水平與抗CCP抗體和RF呈明顯負(fù)相關(guān)(p=0.010,p=0.042)。(3)抗CCP抗體陽性患者血清IL-28B水平明顯低于抗CCP抗體陰性患者和健康對照組(p=0.047,p=0.007)�？笴CP抗體陰性患者和健康對照組之間血清IL-28B水平無統(tǒng)計(jì)學(xué)差異。RF陽性患者血清IL-28B水平明顯低于RF陰性患者和健康對照組(p=0.010,p=0.002)。RF陰性患者和健康對照組之間血清IL-28B水平無統(tǒng)計(jì)學(xué)差異。(4)DMARDs治療前后血清IL-28B水平和TSS之間無相關(guān)性;DMARDs治療6個月后,影像學(xué)有進(jìn)展和無進(jìn)展兩組間血清IL-28B水平的變化有顯著差異(p=0.028)。(5)RA患者在DMARDs治療后疾病活動性降低,但血清IL-28B水平在DMARDs治療前后無明顯差異。結(jié)論:IL-28B在RA中發(fā)揮一定作用,可能有助于減輕患者的骨破壞,成為抑制RA患者骨破壞的一個新靶點(diǎn)。同時,血清IL-28B水平不隨著疾病活動性改變而改變。DMARDs能有效減輕RA患者炎性反應(yīng),但不影響IL-28B分泌代謝。
[Abstract]:Objective: rheumatoid arthritis (rheumatoid arthritis,RA) is a chronic, progressive and inflammatory disease characterized by symmetrical synovitis and bone erosion. Il-28B (IL-28B) is a member of interferon 位 family (also known as type III interferon). It has been studied in many diseases. However, the study of IL-28B in patients with RA has not yet been reported. However, IL-29 (IL-29), another member of interferon 位 family, had 81% homology with IL-28B amino acid, which was overexpressed in serum and synovium of RA patients. It can also promote the expression of pro-inflammatory cytokines IL-6 (IL-6) and IL-8 (IL-8) m RNA) in synovial fibroblasts. The purpose of this study was to investigate the expression of serum IL-28B and its clinical characteristics in patients with RA before treatment, 1 month after treatment, 3 months after treatment and 6 months after treatment. The correlation between laboratory indexes and imaging evaluation was discussed, and then the role of laboratory indexes and imaging evaluation in the diagnosis and treatment of RA was discussed. Methods: 80 patients with RA who met the (ACR) classification standard of the American Society of Rheumatology in 1987 or the (EULAR) 2010 classification standard of the ACR/ European Alliance against Rheumatology were selected and their ages were selected. 80 healthy subjects with no significant gender difference served as control group. Serum IL-28B levels were measured by enzyme-linked immunosorbent assay (Elisa) in 80 patients with RA before DMARDs treatment, 1 month after treatment, 3 months after treatment, 6 months after treatment and 80 healthy subjects. Imaging evaluation using Sharp score (TSS). Clinical data were collected, including age, sex, course of disease, morning stiffness time, joint rest pain, health assessment questionnaire (HAQ), doctor pain assessment, patient pain assessment, joint function grade, joint tenderness number, joint swelling number, Erythrocyte sedimentation rate (ESR), C reactive protein (CRP), platelet, rheumatoid factor (RF), anti-cyclic citrullinated polypeptide (CCP) antibody, immunoglobulin A (Ig-A), immunoglobulin G (Ig-G), Immunoglobulin M (Ig-M); Calculate disease activity scores DAS28-ESR and DAS28-CRP. Results: (1) the level of serum IL-28B in RA patients was significantly lower than that in healthy controls (p 鈮，

本文編號：2493708