来源：风湿病与关节炎,2018,7（7）:10-16.

304例类风湿关节炎患者免疫球蛋白的变化及新风胶囊对其影响（临床研究）

章平衡¹，刘　健²，万　磊²，孙　玥¹

　　【摘　要】目的：观察类风湿关节炎患者免疫球蛋白的变化及新风胶囊（XFC）对其影响。方法：选取304例类风湿关节炎患者，检测血标本中免疫球蛋白IgA、IgG、IgM含量，类风湿因子（RF）、C-反应蛋白（CRP）、红细胞沉降率（ESR）等炎症指标，并计算DAS28评分。同时，采用流式细胞术检测外周血Treg、BTLA表达频率。结果：①304例RA患者中有150例发生免疫球蛋白（IgG或IgA或IgM）改变，发生率为49.34%。其中IgG升高49例（16.12%），IgA升高87例（28.62%），IgM升高14例（4.61%）。②经过12周的治疗后，按照美国风湿病学会（ACR）制定的ACR20/50/70标准，XFC组与来氟米特（LEF）组疗效比较，差异无统计学意义（P > 0.05）。③与治疗前比较，XFC组ESR、CRP水平明显降低，BTLA、Treg明显升高（P < 0.05）；与LEF组比较，XFC组BTLA升高较明显（P < 0.01），其余各指标改变与LEF组比较，差异无统计学意义（P > 0.05）。XFC组中，免疫球蛋白升高组治疗前后比较，其ESR、RF、CRP、IgG、DAS28评分均明显改善（P < 0.05）；免疫球蛋白不升高组治疗前后比较，CRP明显降低（P < 0.05），IgG、IgA均升高（P < 0.05）。④相关性分析结果显示：RA患者外周血中IgG与ESR、RF等疾病活动性指标、VAS、DAS28评分呈正相关，与BTLA、Treg呈负相关（P < 0.05）；IgA与ESR、CRP、RF、抗CCP抗体呈正相关（P < 0.05或P < 0.01）；IgM与ESR、DAS28评分以及医师对疾病活动整体评估（VAS）呈正相关，与BTLA、Treg呈负相关（P < 0.05）。结论：类风湿关节炎患者普遍存在免疫球蛋白水平的改变，并且XFC能够调节Treg、BTLA表达水平，从而进一步改善免疫球蛋白水平，调节类风湿关节炎患者的体液免疫。

　　【关键词】　关节炎，类风湿；免疫球蛋白；新风胶囊

Changes of Immunoglobulin in 304 Patients with Rheumatoid Arthritis and the Effects of Xinfeng Capsule（新风胶囊）on Them

ZHANG Ping-heng,LIU Jian,WAN Lei,SUN Yue

　　【ABSTRACT】Objective:To observe the changes of immunoglobulin in patients with rheumatoid arthritis and the effects of Xinfeng Capsule（XFC,新风胶囊）on them.Methods:Three hundred and four patients with rheumatoid arthritis were selected to detect the contents of immunoglobulin IgA,IgG and IgM,and inflammatory indexes of rheumatoid factor（RF）,C- reactive protein（CRP）and erythrocyte sedimentation rate（ESR）,and DAS28 was calculated.Meanwhile,the expression frequencies of Treg and BTLA in peripheral blood were detected by flow cytometry.Results:①Immunoglobulin（IgG or IgA or IgM）changed in 150 of 304 patients with RA,and the incidence rate was 49.34%.Among them,IgG increased in 49 cases（16.12%）,IgA increased in 87 cases（28.62%）,and IgM increased in 14 cases（4.61%）.②After 12 weeks of treatment,there was no significant difference of curative effect between the XFC group and the leflunomide（LEF）group according to the ACR20/50/70 standard established by the American College for Rheumatology（ACR）（P > 0.05）.③Compared with before treatment,the levels of ESR and CRP in the XFC group decreased significantly,and BTLA and Treg increased significantly（P < 0.05）.Compared with the LEF group,the BTLA of the XFC group increased significantly（P < 0.01）,and the other indexes were not significantly different from those in the LEF group（P > 0.05）.In group XFC,the ESR,RF,CRP,IgG and DAS28 were significantly improved before and after treatment in the elevated immunoglobulin group（P < 0.05）;CRP decreased significantly（P < 0.05）,and IgG and IgA increased（P < 0.05）before and after the treatment in the group without elevation of immunoglobulin.④The results of the correlation analysis showed that IgG was positively related to ESR,RF,VAS and DAS28 in peripheral blood of RA patients,and negatively correlated with BTLA and Treg（P < 0.05）;IgA was positively correlated with ESR,CRP,RF,and Anti CCP antibody（P < 0.05 or P < 0.01）;and IgM was positively correlated ESR,DAS28 and VAS,and negatively correlated with BTLA and Treg（P < 0.05）.Conclusion:The level of immunoglobulin in patients with rheumatoid arthritis is universally altering,and XFC can regulate the expressions of Treg and BTLA,thus further improving the level of immunoglobulin and regulating humoral immunity of patients with rheumatoid arthritis.

　　【Keywords】 arthritis,rheumatoid;immunoglobulin;Xinfeng Capsule（新风胶囊）