中华临床免疫和变态反应杂志2016，Vol.10Issue(4)：357-364,8.DOI:10.3969/j.issn.1673-8705.2016.04.008
托珠单抗对全身型幼年特发性关节炎CD4、 CD8＋T／CD19＋B细胞及免疫球蛋白表达的调控
Regulation of Tocilizumab on the Expression of CD4 +/CD8 +T/CD19 +B Cells and the Immunoglobulin in Systemic Juvenile Idiopathic Arthritis
摘要
Abstract
Objective To study the influence of tocilizumab on lymphocyte subsets , immunoglobulin and bio-chemical indicators of child systemic juvenile idiopathic arthritis ( SJIA) and its clinical efficacy and ad-verse events were observed .Methods Eighteen 18 severe SJIA patients with poor response to DMARDs were divided into two groups , of which eight patients were treated with tocilizumab +DMARDs, 10 pa-tients were treated with placebo +DMARDs ( the control ) group .8 mg/kg of Tocilizumab was infused once every two weeks in hospital if the child's body weight was >30 kg, or 12 mg/kg of Tocilizumab was infused once every two weeks if the child's body weight was <30 kg, injected once .Symptoms and CD3 +, CD4 +, CD8 +T, CD19 +B, CD16 +56 -NK cell ratio in the two groups were tested by the flow cytometry before or 12 weeks after treatment .The levels of immunoglobulin IgG , IgM, IgA, IgE at base-line and after the therapy in two group were compared , and te inflammatory markers ( CRP, ESR, FER, WBC) and ALT/AST changes were monitored , adverse reactions and patients with corticosteroid dose re-duction or discontinuation of corticosteroid were analyzed at weeks 12 after treatment .Results After 12 weeks, the CRP, ESR, FER levels were significantly decreased in the tocilizumab +DMARDs treatment group,, the most frequent adverse reaction was infection , mostly upper respiratory tract infection , fol-lowed by elevated transaminase , cholesterol , low-density lipoprotein High-density lipoprotein and triglyc-eride levels.No serious adverse events ( three-line reduction, severe infections, etc.) of both groups were observed.The proportion of CD4 +T (31.13% ±8.50% vs.31.75% ±12.33%), CD19 + B (15.85%±12.50%vs.18.77%±12.17%) cells in the Tocilizumab group was lower than the baseline (P<0.05), while CD8 (36.34%±19.36%vs.32.00%±19.12%), CD3 +T (75.62%±13.33%vs.68.19% ±18.77%) cells were increased compared with the baseline , however, no significant change with CD16 + 56 -NK cells ( P >0.05 ) , and immunoglobulins IgG ( 8.35% ±2.32% vs. 11.56%±2.99%) , IgM ( 1.18% ±0.39% vs.1.37% ±0.38%) , IgA ( 1.19% ±0.62% vs. 1.50%±0.90%) was lower than the baseline ( P<0.05 ) .There was no significant changes of these parameters in the control group ( P>0.05 ) .Conclusions Tocilizumab can significantly reduce inflam-matory markers (CRP, ESR, FER), but affects lipid metabolism and ALT/AST level.Blocking IL-6 can regulate CD4 +T, CD19 +B cells, and reduce joint destruction .Tocilizumab can effectively control the disease in SJIA patients who are resistant to DMARDs .关键词
托珠单抗/全身型幼年特发性关节炎/白细胞介素-6/淋巴细胞亚群Key words
tocilizumab/systemic juvenile idiopathic arthritis/interleukin-6/lymphocyte subsets分类
医药卫生引用本文复制引用
李洪伟,曾华松..托珠单抗对全身型幼年特发性关节炎CD4、 CD8＋T／CD19＋B细胞及免疫球蛋白表达的调控[J].中华临床免疫和变态反应杂志,2016,10(4):357-364,8.基金项目
广东省省级科技计划项目（2014A020212010），国家高技术研究发展计划（863）子课题 （）
