艾拉莫德对类风湿关节炎患者T细胞亚群中Th1/Th17比值及RORc表达水平的影响

摘要

目的 探究艾拉莫德对类风湿关节炎患者T细胞亚群中Th1/Th17比值及RORe表达水平的影响.方法 选取2014年6月至2016年6月本院风湿内科和骨科收治的64例RA患者为研究对象,按患者入院时间顺序分为观察组和对照组,每组32例;两组患者均给予补钙、止痛及胃黏膜保护等基础对症治疗后,对照组患者口服艾拉莫德模拟片(安慰剂),观察组在基础治疗上服用艾拉莫德治疗;观察比较治疗前后两组患者T细胞亚群中Th1、Th17比例变化和RORe表达水平变化,同时比较两组患者不良反应发生率.结果 治疗后观察组患者Th1、Th17和Th1/Th17等指标较同组治疗前(t=6.420、3.428,7.985)和对照组患者(t=3.596、4.847,2.376)显著降低,差异均有统计学意义(均P＜0.05),且观察组患者调节性T细胞比例显著高于对照组(t=3.159),同时两组患者RORc和T-bet水平较治疗前显著降低(t=9.454、3.128和5.025、2.848),而Foxp3表达水平较治疗前显著升高(t=5.129和3.925),且两组差异均有统计学意义(均P＜ 0.05).两组患者不良反应发生率比较差异无统计学意义(x2=0.217,P＞0.05).结论 艾拉莫德通过下调Th细胞相关转录因子RORc mRNA表达含量,降低Th细胞亚群中Th1、Th7及Th1/Th7比例,并增加调节性T细胞比例,缓解T细胞介导炎症反应,改善患者临床症状,值得临床推广使用.%Objective To explore the effect of iguratimod on the Th1 / Th17 ratio in T lymphocyte subsets and the expression level of RORc in patients with rheumatoid arthritis (RA).Methods Sixty-four patients with RA admitted into the department of rheumatology and the department of orthopaedics at our hospital from June,2014 to June,2016 were divided into an observation group and a control group according to the admission order,32 cases for each group.After being given calcium supplement,pain relief,gastric mucosal protection,and other basic symptomatic treatment,the control group orally took iguratimod placebo and the observation group iguratimod.The changes of Th 1/Th 17 ratio in T lymphocyte subsets and the expression level of RORc before and after treatment were observed and compared between the two groups.And the incidences of adverse reactions were also compared.Results The levels of Th1 and Th17 and Th1/Th17 were significantly lower after than before the treatment (t=6.420,3.428,7.985) and were in observation group than in control group after the treatment (t=3.596,4.847,2.376) (P ＜ 0.05).The proportion of regulatory T cells was significantly higher in the observation group than in the control group after the treatment (t=3.159).The levels of RORc and T-bet (t=-9.454,3.128 and 5.025,2.848) were significantly lower and the expression level of Foxp3 (t=-5.129 and 3.925)was significantly higher after than before the treatment in both group and there were statistical differences between these two group (P ＜ 0.05).There was no statistical difference in the incidence of adverse reactions between these two groups (x2=0.217,P ＞ 0.05).Conclusions Through the down-regulation of the expression level of Th cell related transcription factor RORc mRNA,iguratimod can reduce the proportions of Thl and Th7 and Thl/Th7 in Th cell subsets,increase the proportion of regulatory T cells,alleviate T cell mediated inflammatory reactions,and relieve the patients' clinical symptoms.