目的：研究环孢素A(ciclosporin A，CsA)联合甲氨蝶呤(methotrexate，MTX)治疗对类风湿关节炎(rheumatoid arthritis，RA)患者血清IL-17的表达影响，揭示CsA联合MTX治疗RA的作用机制。方法：收集83例RA经MTX单药或联合CsA治疗的新确诊患者，以及健康志愿者31例。MTX单药治疗组(41例)每周予以MTX(10~15 mg)；CsA联合MTX治疗组42例，予以CsA 3 mg/kg/d和MTX(10~15 mg)每周1次；观察和评价患者治疗3月后血清中IL-17的表达变化，以及与疾病活动度评分、RF、anti-CCP之间的关系。结果：两组RA患者治疗前血清IL-17表达均显著高于正常健康对照组(P<0.001)。与治疗前相比，两组血清中IL-17表达均下降，但MTX单药治疗组无差异性(P=0.062)，联合治疗组中IL-17表达显著性下降(P=0.016)。在MTX和CsA联合治疗组中，IL-17的变化值与anti-CCP(r=0.42，P=0.041)和DAS28(r=0.49，P=0.023)的变化值具有相关性。结论：CsA联合MTX治疗RA的机制与抑制IL-17的表达有一定关系。%Objective: To investigate the role of cyclosporin A (CsA) and methotrexate (MTX) combined therapy in modulation of serum IL-17 express in the patients with rheumatoid arthritis (RA).Methods: 83 new patients with rheumatoid arthritis were collected, which consist of MTX monotherapy (41 cases) and combination of MTX and CsA therapy (42 cases). hTe MTX dose was applied for 10~15 mg per week, and CsA was 3 mg/kg per day. hTe sera IL-17 expression was detected by ELISA before therapy and atfer 3 months treatment. In addition, disease activity index, RF and anti-CCP were also evaluated, and corelation between IL-17 and above clinical parameters were analyzed.Results:hTe levels of IL-17 in AR patients and healthy volunteers were analyzed. As compared with healthy control, AR patients have high level of IL-17 (P<0.001), two group AR patients has no difference. Interestingly, when compared with pre-treatment, the expression of IL-17 was signiifcantly decreased in AR patients with MTX and CsA treatment (P=0.016), while MTX monotherapy has no considerable change (P=0.062). In the MTX and CsA treated group, correlations between the difference of IL-17 and those of clinical and laboratory parameters at baseline and 3 months from initial treatment showed significant correlation with anti-CCP (r=0.42,P=0.041) and DAS28 (r=0.49,P=0.023).Conclusion:The mechanism of CsA and MTX combined therapy in the patients with rheumatoid arthritis might due to the inhibition of IL-17 expression.
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