痛风性关节炎患者血清及组织中IL-17水平研究
发布时间：2019-02-22 09:59
【摘要】：背景：随着生活水平的提高,高尿酸血症和痛风的患病率呈逐年上升的趋势。痛风也得到了越来越多的关注与研究。目前的研究认为痛风急性发作是尿酸盐晶体变化诱发的一个急性炎症过程,经过吞噬细胞、中性粒细胞的参与,诱导产生一系列炎症反应。在整个炎症反应过程中,IL-1β、TNF-α、IL-6、TGF-β、中性粒细胞趋化因子(CXCL1)等多种炎症因子均参与到其中。而IL-17与多种自身免疫病的发病有关,随着IL-17在类风湿性关节炎中的深入研究,证实了IL-17在导致关节炎症改变和骨质破坏中发挥着明确的作用。IL-17主要通过介导滑膜炎症、软骨破坏、骨侵蚀这三方面发挥作用。同样作为一种炎症性关节炎,IL-17是否也参与了痛风患者关节炎的炎症反应,并在其中发挥了不可忽视的作用?为了探讨这一问题,我们做了以下研究。目的：通过测定IL-17在痛风患者中的表达水平,研究痛风患者IL-17是否有异常增高的表达。并探索可能影响痛风患者IL-17水平的临床特点以及IL-17在痛风中可能的作用。方法：1.通过筛选2014年9月-2015年4月北京协和医院痛风门诊的痛风患者,痛风风诊断符合1977年美国风湿病学会(American College of Rheumatology, ACR)分类标准。收集患者基本资料、临床症状、生化指标并留取血清标本。采用Elisa检测痛风患者血清IL-17水平,比较痛风患者与对照组IL-17表达水平差异,分析不同水平IL-17痛风患者临床症状及血生化指标的差异,通过亚组分析和单因素相关性分析影响痛风患者IL-17表达水平的因素。2.通过留取北京协和医院骨科2014年1月-2015年5月因痛风性关节炎行关节手术的患者的关节滑膜组织标本(尽可能靠近痛风石或病变处滑膜组织),做石蜡病理切片,后行免疫组化染色。所有研究对象完成基本资料及临床资料登记。观察Th17细胞在痛风患者关节滑膜组织中是否存在,并分析Th17阳性患者临床特征的特点。结果：1.痛风组患者IL-17检出比例为30.6%(11/36),OA组患者IL-17检出比例为0%(0/20),经四格表X2检验计算得p=0.006,两组病人IL-17检出率上存在显著差异。相比IL-17阴性组患者,IL-17阳性组痛风患者患者病程更长长,受累关节数目更多,IL-6水平更高,并出现显著性差异；IL-6的水平在不同病程、不同发作频率以及不同hsCRP水平的患者之间有显著性差异。各分组均没有发现TNF-a表达水平有显著性差异。2.15名痛风患者中有5名患者的关节组织切片IL-17免疫组化染色结果为阳性,阳性率为33.3%：5名OA患者中没有IL-17免疫组化染色结果为阳性的患者,阳性率为0%(0/5)。结论：1.痛风患者血清IL-17高表达。2.IL-17阳性组痛风患者发病病程更长,受累关节数目更多,IL-6水平更高。3.痛风患者发病病程越长,发作频率越多,hsCRP呈阳性,血清IL-6水平越高。4.痛风患者关节组织中存在能分泌IL-17的细胞。
[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- 伪, 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.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R589.7
本文编号：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- 伪, 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.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R589.7
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相关期刊论文 前2条
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