各種發炎性關節炎的關節液中細胞激素及補體濃度的研究

Synovial Cytokines and Complements in Patients with Inflammatory Synovitis

發炎性關節炎的關節腔內的免疫反應，包括T-型淋巴球，巨噬細胞的活化，及抗原抗體反應，造成補體激活，細胞激素釋放。其檢測結果在臨床上的應用，是否可作為診斷的依據，及療效之參考，亟待評估。本研究的目的即在於比較不同關節炎的關節液中細胞激素及補體濃度的相關性。本研究收集1991年10月至1994月1月間，13個類風濕性關節炎，3個幼年型類風濕性關節炎等16個發炎性關節炎病人為實驗組。29個退化性關節炎為對照組。合計45個關節液分別用比濁計檢法(nephelometry)測定補體C3／C4濃度，及用“三明治”酵素免疫吸附法(ELISA)技術測定可溶性第二介白質受體(SIL-2R)＆α型腫瘤壞死因子(TNF-α)濃度。所得結果經分析發現實驗組病人關節液的補體濃度平均值為C3／C4=59.0／14.76 mg/dl，高於對照組病人關節液的補體平均濃度C3／C4= 25.93／6.82 mg/dl（p值均小於0.01）。細胞激素的分析亦發現實驗組病人關節液的sIL-2R濃度平均值為98.82pM，高於對照組病人關節液的濃度平均值33.78PM（p值小於0.01）。TNF-α濃度，也是實驗組病人37.33Pg/ml高於對照組病人的16.87pg/ml（p值等於0.13）。由上可知：在發炎性關節炎病人的關節液中，補體濃度雖有激活，但仍較血清補體濃度為低。又由sIL-2R濃度之昇高，可知T-淋巴球扮演相當重要的角色，對於補體及巨噬細胞均有明顯影響。

In order to understand the correlating of cytokine level in synovial fluid with different kinds of arthritis, soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-α (TNF-α) were analyzed in 13 patients with rheumatoid arthritis (RA), 3 patients with juvenile rheumatoid arthritis (JRA), and 29 with osteoarthritis (OA). The level of sIL-2R, as measured by a double-antibody 'sandwich' enzyme-linked immunosorbent assay technique, was markedly elevated in synovial fluid of those with inflammatory synovitis, such as RA, & JRA, (p= 0.001). TNF-α level in synovial fluid of patients with inflammatory synovitis was elevated (p= 0.131). The complement levels in joint fluid, measured by nephelometry, were also higher in the group of inflammatory synovitis, than the group with OA (p< 0.01). Our findings indicated that synovial fluid levels of sIL 2-R, and C3/C4 might serve as indicators for inflammatory synovitis characterized by immune system activation.