摘要
目的探讨重组人白介素2(recombinant human interleukin-2,rh IL-2)治疗类风湿关节炎 (rheumatoid arthritis,RA)合并干燥综合征(sjogren syndrome,SS)的疗效,以及对血清B淋巴细胞刺激因 子(B lymphocyte stimulator,Blys)水平的影响。方法选取湖北民族学院附属民大医院2014年2月至 2017年6月RA合并SS患者60例,随机分为两组,治疗组(30例),给予rh IL-2每天5万IU皮下注射,连续治疗5 d,对照组(30例)给与常规抗免疫治疗。应用Schinner试验、唾液流率评价患者SS症状改善情况,应用类风湿关节炎疾病活动评分(28 joint disease activity Score,DAS28),关节肿胀的压痛指数评 价患者RA症状改善情况。采用酶联免疫吸附法(enzyme linked immunosorbent assay,EUSA)检测患者 血清Blys和免疫指标,并对比治疗前后的差异。结果治疗后左眼泪流量改善差值1.51 (95% CI:0. 938-2.082)mm/min、右眼泪流量改善差值1.67 (95% CI:1.095-2. 245) mm/min、唾液流率改善差值 0.21(95% CI:0.049<0.371)mL/min。治疗组患者治疗后Schirmer试验、唾液流率指标均优于对照组 (P<0.05)。治疗组关节肿胀的压痛指数(2.05±0.03)得分较治疗前明显降低(P <0.05)且低于对照 组(P<0.05)。治疗组RA缓解比例较治疗前增高40%(P<0.05)且显著高于对照组(P<0.05)。治 疗后红细胞沉降率(erythrocyte sedimentation tale, ESR)、C 反应蛋白(C reaction protein,CRP)、免疫球蛋白G(immunoglobulin G,IgG)显著下降(P<0.05)。两组治疗后 ESR 改善差值 3.72 ( 95% CI:1.03,5.06)mm/h,CRP 改善差值 1.95(95% C1:0.68,3.47)g/L,IgG 改善差值 2.01 (95% CI:0? 69,4.93)g/L,治疗组患者治疗后血清免疫指标均优于对照组(P<0. 05 )。治疗组患者血清Blys由治疗前(8. 34 ± 3_19)1>8/11^下降到(4.72±2.16)116/1^,差异明显(/><0.05),对照组血清8178治疗后与治疗前对比无 统计学差异(P>0.05)。结论AIL-2通过降低血清BlyS水平减轻自身免疫反应,改善RA合并SS临 床症状,对RA合并SS的治疗效果明显。
Objective To investigate the effect of recombinant human interleukin 2 ( rh IL-2 ) on rheu-matoid arthritis (RA) combined with Sjogren's syndrome (SS) and the level of serum B lymphocyte stimulator (Blys). Methods All of 60 cases of SS patients combined with RA in Universily Hospital of Hubei Univeisity for Nationalities from February 2014 to June 2017 were randomly divided into two groups. Tlie treatment group (30 cases) were given rh IL-2 50000 IU daily by subcutaneous injection for 5 days. Hie control group(30 ca-ses) were given routine anti immunotherapy. The Schirmer test and saliva flow rate were used to evaluate the improvement of patients"SS symptoms. The 28 joint disease activity score(DAS28) and the pressure pain index of the joint swelling were used to evaluate the improvement of the patients "RA symptoms. Enzyme-linked immunosorbent assay(ELISA) was used to detect serum Blys and immune indexes,and the difference was compared before and after treatment. Results The improved difference was respectively 1.51 (95% Cl:0. 938-2. 082) mm/min in left eyetear flow, 1.67 (95% Cl: 1.095-2. 245 ) mm/min in right eye tear flow,and 0. 21. (95% Cl :0.049-0. 371) mL/min in salivary flow rate after treatment. The Schirmer test and salivary flow rate in the treatment group were better than those in the control group (P <0. 05). The joint swelling index in the treatment group was (2. 05 ± 0.03) points, Which significantly lower than that before treatment( P<0. 05) and also lower than the control group( P <0. 05). RA remission rate in treatment group was increased by 40% compared with before treatment ( P < 0. 05 ) and was significantly higher than the control group ( P<0.05 ) . ESR, CRP and IgG were significantly decreased( P <0. 05) after treatment. The improved difference was respectively 3. 72 (95% CI:1.03,5.06) mm/h in ESR, 1.95 (95% CI:0. 68,3. 47) g/L in CRP and the 2. 01 (95% Cl: 0. 69,4. 93 ) g/L in IgG after treatment. The serum immune parameters in the treatment group were better than those in the control group (P < 0. 05) after treatment. The serum Blys in the treatment group were decreased from(8. 34 ± 3. 19) ng/mL to (4. 72 ±2. 16) ng/mL after treatment (P<0. 05 ).While no significant differ-ence has been found in control group before and after treatment. (P >0. 05). Conclusion RhIL-2 can alleviate the autoimmune response and improve the clinical symptoms of RA with SS by lowering serum Blys level which has obvious therapeutic effect on RA with SS.
作者
余莹莹
石天
刘俊龙
袁杰
Yu Yingjring;Shi Tian;Liu Junlong;Yuan Jie(Department of Clinical Laboratory,University Hospital of Hubei Universily for Nationalities,Enshi 445000,China;Department of Blood Transfusion,University Hospital of Hubei University for Nationalilies,Eruhi 445000,China)
出处
《国际免疫学杂志》
CAS
2018年第5期504-508,共5页
International Journal of Immunology
基金
湖北省重点实验室项目(OIR17026A)。
