类风湿关节炎血清IL-28B表达水平及其与临床特征的相关性研究

发布时间：2019-06-05 17:41

【摘要】：目的:类风湿关节炎(rheumatoid arthritis,RA)是一种慢性、进展性、炎症性疾病,以对称性滑膜炎症和骨侵蚀为特征。白细胞介素-28B(IL-28B)是干扰素λ家族(也被称为III型干扰素)的一个成员,它已经在许多疾病中被研究过,然而,有关RA患者中IL-28B的研究尚无报道。而白细胞介素-29(IL-29),干扰素λ家族另一个成员,与IL-28B氨基酸同源性为81%,在RA患者血清、滑膜中过度表达,并能促进促炎性细胞因子白细胞介素-6(IL-6)和白细胞介素-8(IL-8)m RNA在滑膜成纤维细胞的表达。本文旨在探讨在RA患者应用慢作用抗风湿药(DMARDs)治疗前、治疗后1个月、治疗后3个月、治疗后6个月血清IL-28B表达水平及其与患者临床特征、实验室指标及影像学评估的相关性,进而探讨其在RA诊治中的作用。方法:选取80例符合1987年美国风湿病学会(ACR)分类标准或ACR/欧洲抗风湿联盟(EULAR)2010年分类标准的RA患者,并选取与之年龄、性别无明显差异的80名健康体检者作为对照组。用酶联免疫吸附法(ELISA)测定80例RA患者在DMARDs治疗前、治疗后1个月、治疗后3个月、治疗后6个月及80名健康体检者血清IL-28B水平。影像学评估使用Sharp评分(TSS)。收集患者临床数据,包括:年龄、性别、病程、晨僵时间、关节休息痛、健康评估问卷(HAQ)、医生疼痛评估、患者疼痛评估、关节功能分级、关节压痛数、关节肿胀数、红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板、类风湿因子(RF)、抗环瓜氨酸多肽(CCP)抗体、免疫球蛋白A(Ig-A)、免疫球蛋白G(Ig-G)、免疫球蛋白M(Ig-M);计算疾病活动评分DAS28-ESR和DAS28-CRP。结果:(1)RA患者血清IL-28B水平明显低于健康对照组(p=0.020)。(2)RA患者血清IL-28B水平与抗CCP抗体和RF呈明显负相关(p=0.010,p=0.042)。(3)抗CCP抗体阳性患者血清IL-28B水平明显低于抗CCP抗体阴性患者和健康对照组(p=0.047,p=0.007)。抗CCP抗体阴性患者和健康对照组之间血清IL-28B水平无统计学差异。RF阳性患者血清IL-28B水平明显低于RF阴性患者和健康对照组(p=0.010,p=0.002)。RF阴性患者和健康对照组之间血清IL-28B水平无统计学差异。(4)DMARDs治疗前后血清IL-28B水平和TSS之间无相关性;DMARDs治疗6个月后,影像学有进展和无进展两组间血清IL-28B水平的变化有显著差异(p=0.028)。(5)RA患者在DMARDs治疗后疾病活动性降低,但血清IL-28B水平在DMARDs治疗前后无明显差异。结论:IL-28B在RA中发挥一定作用,可能有助于减轻患者的骨破坏,成为抑制RA患者骨破坏的一个新靶点。同时,血清IL-28B水平不随着疾病活动性改变而改变。DMARDs能有效减轻RA患者炎性反应,但不影响IL-28B分泌代谢。
[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，

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