强直性脊柱炎患者外周血 B 细胞亚群的价值。

Value of the peripheral blood B-cells subsets in patients with ankylosing spondylitis.

机构信息

Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.

出版信息

Chin Med J (Engl). 2009 Aug 5;122(15):1784-9.

PMID:19781326

Abstract

BACKGROUND

The role of B-cell remains an enigma in the pathogenesis of ankylosing spondylitis (AS). This study aimed to investigate the distributions of B-cells and subsets in peripheral blood of AS patients and observe their changes in etanercept-treated AS patents.

METHODS

We detected the proportions of CD19(+) B-cell, naive B-cell (CD19(+)CD27-), memory B-cell (CD19(+)CD27dim) and plasmablast (CD19(+)CD27high) in peripheral blood of 66 patients with AS (39 at active stage, 27 at stable stage; 35 patients with peripheral joint involvement, 31 patients with axial involvement alone), 30 patients with rheumatoid arthritis (RA) and 30 healthy volunteers using flow cytometry. And then we observed the changes of the above indexes of 39 active AS patients treated with etanercept in a randomized, double-blind, placebo-controlled trial.

RESULTS

(1) Percentages of CD19(+) B-cells in active or peripheral joint involvement AS patients increased more obviously than those in stable or axial involvement alone AS patients (both P = 0.001), and percentage of CD19(+)CD27high B-cells in AS patients with peripheral joint involvement was significantly higher than that in cases with axial involvement alone or healthy volunteers (P = 0.005 and 0.006, respectively); (2) The percentage of CD19(+) B-cells in AS patients was positively correlated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, Patient's Global Assessment (PGA) scores, total back pain scores and nocturnal back pain scores (r = 0.270, 0.255, 0.251 and 0.266, P = 0.029, 0.039, 0.042 and 0.031, respectively); (3) At week 6 and week 12, there were no statistical differences of the percentages of B-cells and subsets between etanercept group and placebo group of AS patients (P > 0.05); the percentage of CD19(+) B-cells in etanercept group was higher than that in healthy volunteers at week 12 (t = 3.320, P = 0.003).

CONCLUSIONS

Misbalance is present in B-cells and some subsets in peripheral blood of active AS patients with peripheral joint involved. B-cells might play an important role in the pathogenesis of AS patients. The high percentage of CD19(+) B-cells in active AS patients cannot be down-regulated after 12-week etanercept treatment.

摘要

背景

B 细胞在强直性脊柱炎（AS）发病机制中的作用仍然是一个谜。本研究旨在探讨 AS 患者外周血 B 细胞及其亚群的分布，并观察依那西普治疗后 AS 患者的变化。

方法

采用流式细胞术检测 66 例 AS 患者（活动期 39 例，稳定期 27 例；外周关节受累 35 例，单纯中轴受累 31 例）、30 例类风湿关节炎（RA）患者和 30 例健康志愿者外周血中 CD19(+)B 细胞、幼稚 B 细胞（CD19(+)CD27-）、记忆 B 细胞（CD19(+)CD27dim）和浆母细胞（CD19(+)CD27high）的比例。然后，我们观察了 39 例活动期 AS 患者在一项随机、双盲、安慰剂对照试验中依那西普治疗后上述指标的变化。

结果

（1）活动期或外周关节受累 AS 患者的 CD19(+)B 细胞比例升高较稳定期或单纯中轴受累 AS 患者更为明显（均 P = 0.001），外周关节受累 AS 患者的 CD19(+)CD27high B 细胞比例明显高于单纯中轴受累或健康志愿者（P = 0.005 和 0.006）；（2）AS 患者的 CD19(+)B 细胞比例与 Bath 强直性脊柱炎疾病活动指数（BASDAI）评分、患者总体评估（PGA）评分、总背痛评分和夜间背痛评分呈正相关（r = 0.270、0.255、0.251 和 0.266，P = 0.029、0.039、0.042 和 0.031）；（3）第 6 周和第 12 周时，依那西普组和安慰剂组 AS 患者的 B 细胞及其亚群比例无统计学差异（P > 0.05）；第 12 周时，依那西普组 CD19(+)B 细胞比例高于健康志愿者（t = 3.320，P = 0.003）。