标题：血清MK和Th17/调节性T细胞对类风湿关节炎患者病情发生发展的影响

      作者：马信文 1，董泽民 1，王勇 1，李洪 2    (攀枝花市第二人民医院骨外科 1、检验科 2，四川 攀枝花 617065)

      卷次： 2017年28卷13期

      【摘要】 目的 观察Th17/调节性T细胞(Treg)免疫失衡在类风湿关节炎(RA)患者发病时的作用，探讨血清中期因子(MK)和Th17/调节性T细胞(Treg)对RA患者病情发生发展的影响。方法 选取2013年3月至2016年1月在攀枝花市第二人民医院接受治疗的RA患者58例，根据RA是否处于活动期，将26例DAS28≤3.2者纳入非活动组，32例DAS28>3.2纳入活动组，另将 30例健康者作为对照组，采用酶联免疫吸附法对三组受检者的血清MK、白介素-17 (IL-17)、白介素-6 (IL-6)、白介素-23 (IL-23)水平进行检测，利用流式细胞术检测调节性T细胞和外周血Th17细胞的比例变化，并对其比例变化和血清MK、IL-17、IL-6、IL-23的水平进行比较。结果 活动组患者的Th17、调节性T细胞比例分别为(1.90±1.00)%、(1.58±1.03)%，非活动组分别为(0.98±0.36)%、(3.92±1.29)%，对照组分别为(0.57±0.21)%、(8.01±1.44)%，活动组血清MK为(342.36±68.39) pg/mL，非活动组为(257.91±56.79) pg/mL，对照组为(200.14±83.42) pg/mL，活动组血清MK及Th17、调节性T细胞比例分别与非活动组比较，差异均具有统计学意义(P<0.05)，活动组与非活动组的血清MK及Th17、调节性T细胞比例分别与对照组比较，差异均具有统计学意义(P<0.05)。活动组 IL-17、IL-6和 IL-23分别为(28.74±4.37) ng/L、(12.84±2.38) ng/L、(74.27±11.74) ng/L，非活动组分别为(19.25±3.27) ng/L、(9.36±2.74) ng/L、(52.29±13.83) ng/L，对照组分别为(6.01±3.28) ng/L、(5.99±2.92) ng/L、(27.37±10.27) ng/L，活动组与非活动组的 IL-17、IL-6和 IL-23水平分别与对照组比较，差异均具有统计学意义(P<0.05)。结论 RA患者的血清MK上升，且类风湿性关节炎患者Th17/Treg平衡中Th17相对增高，而Treg会相对降低，MK的上升和Th17/Treg平衡失调都促进了RA的发生发展。
      【关键词】 中期因子；调节性T细胞；类风湿关节炎
      【中图分类号】 R593.22 【文献标识码】 A 【文章编号】 1003—6350（2017）13—2128—03

Effects of serum MK and Th17/ regulatory T cells on the development of rheumatoid arthritis.
MA Xin-wen 1,DONG Ze-min 1, WANG Yong 1, LI Hong 2. Orthopeadic Surgery 1, Clinical Laboratory 2, the Second People's Hospital ofPanzhihua, Panzhihua 617065, Sichuan, CHINA
【Abstract】 Objective To investigate the role of Th17/ regulatory T (Treg) cells imbalance in onset patientswith rheumatoid arthritis (RA), and to explore the effects of serum midkine (MK) and Th17/Treg cells balance on the de-velopment of RA. Methods A total of 58 cases of RA patients treated in the Second People's Hospital of Panzhihua be-tween March 2013 to January 2016 were enrolled. According to whether RA was active, patients were divided into inac-tive group (DAS28≤3.2, 26 cases), and active group (DAS28>3.2, 32 cases), and 30 healthy people were selected ascontrols. Enzyme linked immunosorbent assay (ELISA) was used to detect in three groups the levels of serum MK, inter-leukin-17 (IL-17), IL-6 and IL-23; flow cytometry was used to analyze the proportional change of Th17 cells and Tregcells in peripheral blood. Comparison were explored on the change between the proportion of Th17 cells and Treg cells,serum MK level and values of IL-17, IL-6, IL-23. Results The proportion of Th17 cells and Treg cells in active groupwere (1.90±1.00)%, (1.58±1.03)%, respectively, which were (0.98±0.36)%, (3.92±1.29)% in inactive group and (0.57±0.21)%, (8.01±1.44%)% in control group, respectively. The level of serum MK in active group was (342.36±68.39) pg/mL,(257.91±56.79) pg/mL in inactive group and (200.14±83.42) pg/mL in control group. All the results (the level of serumMK and the propotion of Th17 and Treg cells) showed statistically significant difference between active group and inac-tive group (P<0.05). The levels of IL-17, IL-6 and IL-23 in active group were (28.74±4.37) ng/L, (12.84±2.38) ng/L,(74.27±11.74) ng/L, respectively, (19.25±3.27) ng/L, (9.36±2.74) ng/L, (52.29±13.83) ng/L in inactive group, and (6.01±3.28) ng/L, (5.99±2.92) ng/L, (27.37±10.27) ng/L in control group, respectively. Statistically differences were showedboth in active group and inactive group when compared to the control group (P<0.05). Conclusion Serum MK level Issignificantly elevated in RA patients, who revealed a relatively high frequency of Th17 cells and low number of Tregcells on Th17/Treg balance. An elevated serum MK level and impared Th17/Treg balance both promote the occurrenceand development of RA.
      【Key words】 Midkine; Regulatory T cells; Rheumatoid arthritis·论 著·doi:10.3969/j.issn.1003-6350.2017.13.020