贵州医科大学学报

2018, v.43;No.211(04) 445-449+453

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不同亚型幼年特发性关节炎患者免疫功能特征
Immune Function and Its Clinical Significance in Different Subtypes of Children with Juvenile Idiopathic Arthritis

陶琳琳;周娟;唐雪梅;丁媛;朱晓萍;
TAO Linlin;ZHOU Juan;TANG Xuemei;DING Yuan;ZHU Xiaoping;Guizhou Medical University;Department of Rheumatology and Immunology,Children's Hospital Affiliated to Chongqing Medical University;Children's Medical Center,the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:分析不同亚型幼年特发性关节炎(JIA)细胞免疫及体液免疫特征。方法:按照国际联盟风湿病协会标准将164例JIA活动期患儿分为全身型、多关节型、少关节型及附着点型4组,同期50例健康儿童作为对照组;检测各组被检者血常规及C反应蛋白(CRP)、血沉(ESR)以及降钙素原(PCT)水平,观察各组相关自身抗体阳性率,对患儿进行幼年关节炎活动评分(JADAS-27),流式细胞术检测淋巴细胞亚群CD3~+、CD4~+、CD8~+、CD_(16)~+CD_(56)~+、CD_(19)~+及CD4~+/CD8~+比值,散射比浊法检测免疫球蛋白(Ig)IgG、IgM、IgA及补体C3、C4水平,对不同亚型JIA淋巴细胞亚群与JADAS-27评分进行相关性分析。结果:全身型组JIA患儿白细胞、血小板升高及贫血患者比例较高,CRP、ESR、降钙素原均高于其他各型JIA患儿(P<0.05);部分JIA患儿自身抗体阳性,多关节型及附着点型JIA患儿JADAS-27评分明显升高,高于其他两型(P<0.05);全身型JIA患儿CD8~+细胞水平高于少关节型、多关节型及附着点型(P<0.05),NK细胞水平低于少关节型(P<0.05);多关节型JIA患儿的CD4~+/CD8~+比值明显高于其它亚型(P<0.05);附着点型JIA患儿IgG、IgM、IgA、C_3、C_4水平均高于少关节型;多关节型JIA患儿JADAS-27评分与CD8~+呈负相关(r_1=-0.36,P<0.05),附着点型JIA患儿的JADAS-27评分与CD4~+呈正相关(r_2=0.42,P<0.05)。结论:细胞及体液免疫均参与JIA各亚型发病过程,但不同亚型表现出不同的细胞和体液免疫特征。
Objective: To investigate the changes of cellular and humoral immunity in different subtypes of juvenile idiopathic arthritis( JIA). Methods: 164 children with JIA and 50 healthy controls were recruited into this study. Flow cytometry was used to detect lymphocyte subsets CD_3~+,CD_4~+,CD_8~+,CD_(16)~+CD_(56)~+,CD_(19)~+ and CD4/CD8 ratios. The Immunoglobulin( Ig) IgG,IgM,IgA and complement C_3 and C_4 levels were explored by scatter turbidimetry,as well as to analysis patients of clinical data. Results: In the group of systemic onset JIA( So-JIA),the levels of CRP,ESR and PCT significantly increased( P < 0. 05). In the group of So-JIA,the levels of CD8~+ were higher than those in the oligoarthritis,polyarthritis and ERA groups( P < 0. 05),and the levels of NK were lower than those in the oligoarthritis group( P < 0. 05),In the group of polyarthritis JIA,the ratios of CD4/CD8 were higher than those in other subtypes( P < 0. 05). In the group of ERA,the levels of Ig G,IgM,IgA,C_3 and C_4 were higher than those in the oligoarthritis groups( P < 0. 05). JADAS-27 was negatively correlated with CD8~+ in the group of polyarthritis JIA( P < 0. 05),while JADAS-27 was positively correlated with CD4~+ in ERA( P < 0. 05). Conclusions: Cellular and humoral immunity disorders are involved in various subtypes of children with JIA,while different subtypes of cellular and humoral immunity take on different features.

关键词(KeyWords): 免疫球蛋白;补体;血沉;降钙素原;T淋巴细胞亚群;免疫功能;幼年特发性关节炎
immunoglobulin;addiment;procalcitonin;T lymphocyte subsets;immunologic function;juvenile idiopathic arthritis

Abstract:

Keywords:

基金项目(Foundation): 重庆市科委科研项目(cstc2014jcyj A10023)

作者(Author): 陶琳琳;周娟;唐雪梅;丁媛;朱晓萍;
TAO Linlin;ZHOU Juan;TANG Xuemei;DING Yuan;ZHU Xiaoping;Guizhou Medical University;Department of Rheumatology and Immunology,Children's Hospital Affiliated to Chongqing Medical University;Children's Medical Center,the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2018.04.015

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