类风湿关节炎患者外周血IL-23/IL-17轴与病情的关系及对骨破坏进展的预测价值

doi:10.3969/j.issn.1006-6233.2024.10.022

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摘要 目的:探讨类风湿关节炎(RA)患者外周血白介素-23(IL-23)/白介素-17(IL-17)轴与病情的关系及对骨破坏进展的预测价值。方法:选取2022年5月至2023年10月RA患者118例,根据疾病活动度(DSA28)评分分为轻度活动患者、中度活动患者、重度活动患者,均根据病情给予对症治疗,随访6个月,根据是否发生骨破坏进展分为进展组(27例)与无进展组(91例),于所有患者入院后次日清晨采集空腹静脉血3mL,以酶联免疫法检测外周血IL-23/IL-17轴因子[IL-23、IL-17、白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]水平,分析IL-23/IL-17轴因子与疾病活动度的相关性,评价IL-23/IL-17轴因子对骨破坏进展的预测价值。结果:进展组病程、疾病活动度高于无进展组(P<0.05);进展组外周血IL-23、IL-17、IL-1β、IL-6、TNF-α水平[(192.38±48.72)pg/mL、(31.13±7.24)pg/mL、(88.71±29.10)pg/mL、(18.59±4.21)pg/mL、(180.31±41.57)ng/L]高于无进展组[(149.07±42.15)pg/mL、(25.04±5.39)pg/mL、(56.92±16.52)pg/mL、(15.16±3.44)pg/mL、(142.59±36.62)ng/L](P<0.05);外周血IL-23、IL-17、IL-1β、IL-6、TNF-α在轻度活动患者、中度活动患者、重度活动患者中呈依次升高趋势(P<0.05);外周血IL-23、IL-17、IL-1β、IL-6、TNF-α水平与疾病活动度呈正相关(P<0.05);偏相关性分析显示,在剔除病程、疾病活动度之后,外周血IL-23、IL-17、IL-1β、IL-6、TNF-α与RA患者骨破坏进展显著相关(P<0.05);外周血IL-23、IL-17、IL-1β、IL-6、TNF-α预测RA患者骨破坏进展的AUC分别为0.807、0.804、0.793、0.792、0.794,敏感度分别为81.48%、74.07%、74.07%、85.19%、66.67%,特异度分别为70.33%、75.82%、73.63%、71.43%、80.22%;联合预测RA患者骨破坏进展的AUC为0.931,敏感度为85.19%,特异度为87.91%,明显优于各指标单独预测(Z=2.715、2.803、3.026、3.114、2.984,P均<0.001)。结论:外周血IL-23/IL-17轴因子与RA患者病情活动显著相关,对骨破坏进展具有可靠的预测价值。

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	马中双
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	刘颖

关键词 ：类风湿关节炎, 白介素-23/白介素-17轴, 病情活动, 相关性, 骨破坏进展, 预测价值

Abstract：Objective: To investigate the relationship between the interleukin-23 (IL-23)/interleukin-17 (IL-17) axis in the peripheral blood of patients with rheumatoid arthritis (RA) and disease activity, and its predictive value for the progression of bone destruction. Methods: A total of 118 RA patients were enrolled between May 2022 and October 2023. They were divided into mild, moderate, and severe disease activity groups according to the Disease Activity Score 28 (DAS28) and received symptomatic treatment based on their condition. Patients were followed up for 6 months, and were further divided into a progression group (27 cases) and a non-progression group (91 cases) based on the presence of bone destruction progression. Fasting venous blood (3 mL) was collected from each patient on the morning after admission, and the levels of IL-23/IL-17 axis factors [IL-23, IL-17, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)] were measured using enzyme-linked immunosorbent assay (ELISA). The correlation between IL-23/IL-17 axis factors and disease activity was analyzed, and the predictive value of these factors for bone destruction progression was evaluated. Results: The disease course and disease activity in the progression group were significantly higher than those in the non-progression group (P<0.05). The levels of IL-23, IL-17, IL-1β, IL-6, and TNF-α in the peripheral blood of the progression group [(192.38±48.72) pg/mL, (31.13±7.24) pg/mL, (88.71±29.10) pg/mL, (18.59±4.21) pg/mL, (180.31±41.57) ng/L] were higher than those in the non-progression group [(149.07±42.15) pg/mL, (25.04±5.39) pg/mL, (56.92±16.52) pg/mL, (15.16±3.44) pg/mL, (142.59±36.62) ng/L] (P<0.05). The levels of IL-23, IL-17, IL-1β, IL-6, and TNF-α in the peripheral blood showed a progressive increase from patients with mild to moderate to severe disease activity (P<0.05). The levels of IL-23, IL-17, IL-1β, IL-6, and TNF-α were positively correlated with disease activity (P<0.05). Partial correlation analysis showed that after excluding the influence of disease course and disease activity, IL-23, IL-17, IL-1β, IL-6, and TNF-α remained significantly correlated with the progression of bone destruction in RA patients (P<0.05). The area under the curve (AUC) values for IL-23, IL-17, IL-1β, IL-6, and TNF-α in predicting the progression of bone destruction in RA patients were 0.807, 0.804, 0.793, 0.792, and 0.794, with sensitivities of 81.48%, 74.07%, 74.07%, 85.19%, and 66.67%, and specificities of 70.33%, 75.82%, 73.63%, 71.43%, and 80.22%, respectively. The combined prediction of bone destruction progression had an AUC of 0.931, with a sensitivity of 85.19% and specificity of 87.91%, which was significantly superior to the individual predictions (Z=2.715, 2.803, 3.026, 3.114, 2.984, all P<0.001). Conclusion: The IL-23/IL-17 axis in peripheral blood is significantly associated with disease activity in RA patients and has a reliable predictive value for the progression of bone destruction.

Key words： Rheumatoid Arthritis IL-23/IL-17 Axis Dsease activity Correlation Bone destruction progression Predictive value

基金资助:江苏省优势学科建设工程项目,(编号:YSHL2101-091)

通讯作者: 刘颖

引用本文:

马中双, 朱红红, 刘颖. 类风湿关节炎患者外周血IL-23/IL-17轴与病情的关系及对骨破坏进展的预测价值[J]. 河北医学, 2024, 30(10): 1700-1704.
MA Zhongshuang, ZHU Honghong, LIU Ying. The Relationship between IL-23/IL-17 Axis in Peripheral Blood and Disease Activity in Patients with Rheumatoid Arthritis and Its Predictive Value for Bone Destruction Progression. HeBei Med, 2024, 30(10): 1700-1704.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.10.022 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I10/1700

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