抗合成酶综合征与类风湿关节炎重叠患者的免疫学特征
[Immunological characteristics of patients with anti-synthetase syndrome overlap with rheumatoid arthritis].
作者信息
Zhao Liang, Shi Chenglong, Ma Ke, Zhao Jing, Wang Xiao, Xing Xiaoyan, Mo Wanxing, Lian Yirui, Gao Chao, Li Yuhui
机构信息
Department of Rheumatology and Immunology, Peking University People' s Hospital, Beijing 100044, China.
Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Dec 18;56(6):972-979. doi: 10.19723/j.issn.1671-167X.2024.06.005.
OBJECTIVE
To investigate the clinical and immunological characteristics of anti-synthetase syndrome (ASS) patients overlap with rheumatoid arthritis (RA).
METHODS
A retrospective analysis was conducted on ASS patients with arthritis who were treated at Peking University People' s Hospital. Data collected included demographic information, clinical manifestations, laboratory features, lymphocyte subsets in peripheral blood, and treatments. The patients with ASS were divided into two groups based on the presence or absence of RA for comparative analysis.
RESULTS
A total of 104 ASS patients with arthritis were included, among whom 23.1% (24/104) were diagnosed with RA. The ASS with RA group had a significantly higher incidence of rapidly progressive interstitial lung disease (RP-ILD) (41.7% . 17.6%, =0.032), number of tender joints [10 (7, 14) . 4 (0, 8), < 0.001], number of swollen joints [4 (2, 8) . 2 (0, 4), =0.012], and rate of bone erosion (47.8% . 2.5%, < 0.001) compared with the non-RA group. Levels of platelets [(289.57±68.74)×10/μL . (247.94±77.04)×10/μL, =0.022], erythrocyte sedimentation rate (ESR) [43 (19, 59) mm/h . 18 (10, 44) mm/h, =0.019], and C-reactive protein (CRP) [19.20 (4.80, 55.36) mg/L . 5.68 (1.10, 14.96) mg/L, =0.006] were found significantly higher in the ASS with RA group than those in non-RA group. Analysis of immune cells in peripheral blood mononuclear cell (PBMC) showed that significantly decreased proportions of CLA Treg cells [(11.12±4.10)% . (17.22±8.49)%, =0.003], B cells [8.56% (4.80%, 11.90%) . 14.55% (8.75%, 20.29%), =0.025], and natural killer (NK) cells [7.56% (4.65%, 13.20%) . 13.25% (7.46%, 19.25%), =0.045] in the overlap group compared with non-RA group. Proportion of Naïve Th cells [(52.66±17.66)% . (40.76±14.96)%, =0.033)] was significantly increased in overlap group compared with non-RA group. Overlap group had lower rate of complete clinical response than non-RA group (16.7% . 43.8%, =0.031).
CONCLUSION
Among ASS patients with arthritis, those with RA have more severe lung and joint involvement and a lower treatment response rate, highlighting the need for early recognition and aggressive intervention.
目的
探讨抗合成酶综合征（ASS）合并类风湿关节炎（RA）患者的临床及免疫学特征。
方法
对北京大学人民医院收治的合并关节炎的ASS患者进行回顾性分析。收集的数据包括人口统计学信息、临床表现、实验室检查结果、外周血淋巴细胞亚群及治疗情况。根据是否合并RA将ASS患者分为两组进行对比分析。
结果
共纳入104例合并关节炎的ASS患者，其中23.1%（24/104）诊断为RA。与非RA组相比，合并RA的ASS组快速进展性间质性肺病（RP-ILD）发生率显著更高（41.7% 对17.6%，P=0.032），压痛关节数[10（7，14）对4（0，8），P<0.001]、肿胀关节数[4（2，8）对2（0，4），P=0.012]及骨侵蚀率（47.8% 对2.5%，P<0.001）均更高。合并RA的ASS组血小板水平[（289.57±68.74）×10⁹/μL对（247.94±77.04）×10⁹/μL，P=0.022]、红细胞沉降率（ESR）[43（19，59）mm/h对18（10，44）mm/h，P=0.019]及C反应蛋白（CRP）[19.20（4.80，55.36）mg/L对5.68（1.10，14.96）mg/L，P=0.006]显著高于非RA组。外周血单个核细胞（PBMC）免疫细胞分析显示，与非RA组相比，重叠组皮肤淋巴细胞相关抗原调节性T细胞（CLA Treg细胞）比例显著降低[（11.12±4.10）%对（17.22±8.49）%，P=0.003]、B细胞[8.56%（4.80%，11.90%）对14.55%（8.75%，20.29%），P=0.025]及自然杀伤（NK）细胞[7.56%（4.65%，13.20%）对13.25%（7.46%，19.25%），P=0.045]。与非RA组相比，重叠组初始T细胞比例显著升高[（52.66±17.66）%对（40.76±14.96）%，P=0.033]。重叠组完全临床缓解率低于非RA组（16.7%对43.8%，P=0.031）。
结论
在合并关节炎的ASS患者中，合并RA者肺部和关节受累更严重，治疗缓解率更低，强调早期识别和积极干预的必要性。
Zotero 插件