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用于早期识别类风湿关节炎对 TNF 抑制剂无缓解的血液淋巴细胞亚群。

Blood Lymphocyte Subsets for Early Identification of Non-Remission to TNF Inhibitors in Rheumatoid Arthritis.

机构信息

Department of Immunology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain.

Immuno-Rheumatology Research Group, IdiPaz Hospital Universitario La Paz, Madrid, Spain.

出版信息

Front Immunol. 2020 Aug 27;11:1913. doi: 10.3389/fimmu.2020.01913. eCollection 2020.

Abstract

TNF inhibitors (TNFis) are widely used for the treatment of rheumatoid arthritis (RA), although the response rates to this therapy in patients with RA remains heterogeneous and < 50% achieve remission (REM). To analyze baseline peripheral blood leukocytes profiles in order to search for biomarkers identifying patients who will most likely not achieve REM under TNFi treatment. A prospective bi-center pilot study including 98 RA patients treated with TNFis and followed-up during 6 months. Patients were classified according to DAS28 as follows: those who achieved REM (DAS28 ≤ 2.6) and those who did not (DAS28 > 2.6) at 6 months after starting TNFis. These rates were also assessed by simplified disease activity index (SDAI ≤ 3.3 and SDAI > 3.3, respectively). Peripheral blood immune cells were studied by flow cytometry before treatment initiation. At 6 months, 61 or 80% of patients did not achieve REM by DAS28 or SDAI, respectively. Basal leukocyte profiles differed between REM vs. non-REM patients. Non-REM patients showed lower percentages of total and naïve B cells at baseline than REM subjects. A B lymphocyte/CD4+ lymphocyte ratio (BL/CD4 ratio) <0.2 clearly associated with a higher probability of non-REM status based on DAS28 at 6 months (OR = 9.2, = 0.006). These data were confirmed when patient response was evaluated by SDAI index. Our results strongly suggest that BL/CD4 ratio could be considered as a useful biomarker for the early identification of non-remitters to TNFi in clinical practice.

摘要

肿瘤坏死因子抑制剂(TNFis)广泛用于治疗类风湿关节炎(RA),尽管 RA 患者对此类治疗的反应率仍存在异质性,<50%的患者达到缓解(REM)。本研究旨在分析基线外周血白细胞谱,以寻找可识别最不可能通过 TNFi 治疗达到 REM 的患者的生物标志物。这是一项前瞻性双中心试点研究,共纳入 98 例接受 TNFi 治疗并随访 6 个月的 RA 患者。根据 DAS28 将患者分为 REM 组(DAS28≤2.6)和非 REM 组(DAS28>2.6)。同时通过简化疾病活动指数(SDAI≤3.3 和 SDAI>3.3)评估这两组。在开始 TNFi 治疗前通过流式细胞术研究外周血免疫细胞。6 个月时,61%或 80%的患者通过 DAS28 或 SDAI 分别未达到 REM。REM 组与非 REM 组的基线白细胞谱不同。非 REM 患者的总 B 细胞和幼稚 B 细胞百分比明显低于 REM 患者。基于 DAS28,BL/CD4 比值<0.2 与 6 个月时非 REM 状态的更高可能性明显相关(OR=9.2, =0.006)。当根据 SDAI 指数评估患者的反应时,这些数据得到了证实。我们的研究结果强烈表明,BL/CD4 比值可作为临床实践中 TNFi 早期识别非缓解者的有用生物标志物。

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