来源：风湿病与关节炎,2018,7（7）:17-20,32.

类风湿关节炎患者B细胞功能变化及其相关性分析（临床研究）

潘　惠¹，汪　元²

　　【摘　要】目的：探讨类风湿关节炎患者外周血中B细胞功能的变化及其与实验室指标、中医证候的关系。方法：选取60例类风湿关节炎患者，根据DAS28评分，分为高活动组24例，中低活动组36例；同时选取20例健康体检者为正常对照组。采用流式细胞仪检测B细胞计数、B细胞百分比；采用ELISA法检测抗环瓜氨酸肽（CCP）抗体、B细胞活化因子（BAFF）及其受体（BAFF-R）；采用免疫透射比浊法检测免疫球蛋白IgA、IgG、IgM，补体C3、C4及类风湿因子（RF）、C-反应蛋白（CRP）；采用全自动血沉分析仪检测红细胞沉降率（ESR）。结果：类风湿关节炎患者的B细胞计数、B细胞百分比、BAFF、BAFF-R较正常对照组明显增高（P < 0.05），且高活动组较中低活动组明显增高（P < 0.01）。B细胞计数与RF、抗CCP抗体、ESR、CRP、C3、IgG呈正相关（P < 0.05）；B细胞百分比与抗CCP抗体、ESR、CRP、C4呈正相关（P < 0.05）；BAFF与抗CCP抗体、ESR、CRP、C3、IgG呈正相关（P < 0.05）；BAFF-R与CRP呈正相关（P < 0.05）。B细胞计数与关节肿胀、关节压痛、关节局部发热、疲倦乏力、舌质紫暗呈正相关（P < 0.05），B细胞百分比与关节肿胀、关节压痛、关节局部发热、纳食减少呈正相关（P < 0.05），BAFF与关节肿胀、关节压痛、关节局部发热呈正相关（P < 0.05），BAFF-R与纳食减少、大便稀溏呈正相关（P < 0.05）。结论：类风湿关节炎患者的B细胞功能较正常人明显升高，与疾病活动度、中医证候呈正相关，说明B细胞功能变化可作为反映类风湿关节炎病情活动度的指标之一。

　　【关键词】　关节炎，类风湿；B细胞功能；疾病活动度；中医证候

Changes of B Cell Function in Patients with Rheumatoid Arthritis and Correlation Analysis

PAN Hui,WANG Yuan

　　【ABSTRACT】Objective:To investigate the changes of B cell function in peripheral blood of patients with rheumatoid arthritis and their relationship with laboratory indexes and TCM syndromes.Methods:Sixty cases of rheumatoid arthritis were selected and divided into a high activity group（24 cases）,a middle and a low activity group（36 cases）according to DAS28 score,and 20 healthy subjects were selected as a normal control group.The B cell count and the percentage of B cells were detected by flow cytometry.The anti CCP antibody,BAFF and its receptor BAFF-R were detected by ELISA,and immunoturbidimetry was used to detect immunoglobulin IgA,IgG,IgM,complement C3,C4 and rheumatoid factor（RF）and C-reactive protein（CRP）.Erythrocyte sedimentation rate（ESR）was detected by automatic ESR analyzer.Results:The number of B cells,the percentage of B cells,BAFF and BAFF-R in the patients with rheumatoid arthritis were significantly higher than those in the normal control group（P < 0.05）,and those in the high activity group were significantly higher than the low activity group（P < 0.01）.The number of B cells was positively correlated with RF,anti CCP antibody,ESR,CRP,C3 and IgG（P < 0.05）,and the percentage of B cells was positively correlated with anti CCP antibody,ESR,CRP and C4（P < 0.05）.BAFF was positively correlated with anti CCP antibody,ESR,CRP,C3 and IgG（P < 0.05）.BAFF-R was positively correlated with CRP（P < 0.05）.There was a positive correlation between B cell count and joint swelling,joint tenderness,joint local fever,fatigue and lingual purple（P < 0.05）.The percentage of B cells was positively correlated with joint swelling,joint tenderness,joint local fever,and reduction of food intake（P < 0.05）.BAFF was positively correlated with joint swelling,joint tenderness,and joint local fever（P < 0.05）.BAFF-R was positively correlated with food intake reduction and loose stool（P < 0.05）.Conclusion:The B cell function of patients with rheumatoid arthritis is significantly higher than that of normal people,and it is positively related to the degree of disease activity and TCM syndrome,indicating that the function of B cells can be used as one of the indexes to reflect the degree of activity of rheumatoid arthritis.

　　【Keywords】 arthritis,rheumatoid;B cell function;disease activity;TCM Syndromes