来源：风湿病与关节炎,2018,7（4）:11-15.

TLRs/MyD88与痛风性关节炎的相关性研究（临床研究）

刘　静¹，谢克琴²，曹跃朋²，刘正奇²，邓志勇²，李　贺²，孙贵炎²，吕宁霁²，

马武开²，钟　琴²

　　【摘　要】目的：研究Toll样受体2（TLR2）、Toll样受体4（TLR4）、髓样分化因子88（MyD88）与痛风性关节炎患者临床及实验室指标的相关性。方法：选取120例痛风性关节炎患者，其中急性痛风性关节炎患者（急性组）76例，非急性痛风性关节炎患者（非急性组）44例；另选取健康者20例为健康对照组。记录所有患者的一般情况、病程、疼痛视觉模拟评分法（VAS）评分，检查肾功能、C-反应蛋白（CRP）、红细胞沉降率（ESR），酶联免疫吸附测定法（ELISA）检测TLR2、TLR4、MyD88在外周血的浓度，采用SPSS 22.0软件分析痛风性关节炎患者的外周血TLR2、TLR4、MyD88与各指标的相关性。结果：①痛风性关节炎患者外周血TLR2、TLR4、MyD88浓度较健康对照组显著升高，差异有统计学意义（P < 0.01）；急性组患者外周血TLR2、TLR4、MyD88浓度较非急性组明显升高（P < 0.01）。②病程< 1年、1～5年、5～10年、> 10年的患者外周血TLR2、TLR4、MyD88比较，病程 < 1年的患者外周血TLR2、TLR4高，差异有统计学意义（P < 0.05）；其他病程段的痛风患者两两比较，差异无统计学意义（P > 0.05）。急性组患者VAS评分、ESR、CRP高于非急性组，差异有统计学意义（P < 0.01）。非急性组患者外周血尿酸高于急性组，差异有统计学意义（P < 0.05）；2组尿素氮、肌酐、胱抑素C比较，差异无统计学意义（P > 0.05）。④痛风性关节炎患者外周血TLR2、TLR4、MyD88与CRP、ESR呈线性正相关（P < 0.01或P < 0.05）。结论：TLR2、TLR4、MyD88参与了痛风性关节炎患者的发生、发展，尤其在急性期。

　　【关键词】　痛风性关节炎；Toll样受体；髓样分化因子88；相关性

Study on the Correlation Between TLRs/MyD88 and Gouty Arthritis

LIU Jing,XIE Ke-qin,CAO Yue-peng,LIU Zheng-qi,DENG Zhi-yong,LI He,SUN Gui-yan,LYU Ning-ji,MA Wu-kai,ZHONG Qin

　　【ABSTRACT】Objective:To study the correlation between clinical and laboratory indexes of TLR2, TLR4 and MyD88 in patients with gouty arthritis.Methods:One hundred and twenty cases of gouty arthritis were divided into an acute group（76 cases）and a non-acute group（44 cases）,and twenty 20 healthy people were chosen as a control group.The general condition,course of disease,pain visual analogue scale（VAS）scores of all patients were recorded.The renal function,C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were checked.The enzyme linked immunosorbent assay（ELISA）were used to detect the concent-rations of TLR2,TLR4,MyD88 in peripheral blood,and the software SPSS 22.0 was used to analyze the correlation between TLR2,TLR4 and MyD88 in peripheral blood and all the indexes.Results:①The concentrations of TLR2,TLR4 and MyD88 in the peripheral blood of patients with gouty arthritis were significantly higher than those in the healthy control group,and the difference was statistically significant（P < 0.01）.The concentrations of TLR2,TLR4 and MyD88 in the peripheral blood of the acute group was significantly higher than those in the non-acute group（P < 0.01）.②Comparison among patients respectively with disease course of less than 1 year,1~5 years,5~10 years and over 10 years,TLR2 and TLR4 of those with less than 1 year of disease course were higher,and the difference was statistically significant（P < 0.05）.There was no statistical significance between  patients with the other different disease courses（P > 0.05）.③The VAS score,ESR and CRP in the acute group were significantly higher than those in the non-acute group,and the difference was statistically significant（P < 0.01）.The peripheral blood uric acid in the non-acute group was higher than that in the acute group,and the difference was statistically significant（P < 0.05）.The differences of urea nitrogen,creatinine and cystatin C in the two groups were not statistically significant（P > 0.05）.④TLR2,TLR4 and MyD88 in peripheral blood of patients with gouty arthritis were positively correlated with CRP and ESR（P < 0.01 or P < 0.05）.Conclusion:TLR2,TLR4 and MyD88 are involved in the occurrence and development of gouty arthritis,especially in acute phase.

　　【Keywords】 gouty arthritis;Toll-like receptor;MyD88;correlation