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目的探讨“5.12”地震后北川羌族人群中类风湿关节炎(RA)患者外周血T细胞亚群的表达情况并分析创伤后应激障碍(PTSD)对RA患者细胞免疫之间的影响。方法 2009年3月-2010年3月,对98例北川羌族RA患者、112例健康对照,以及同期绵阳郊区84例RA患者、120例健康对照进行分析。用流式细胞仪分别检测CD3+、CD3+CD4+、CD3+CD8+T淋巴细胞数及CD4/+CD8+比值,RA疾病活动性采用DAS28测定,应用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准调查RA人群中的PTSD患者,应用PTSD检查表平时版(PCL-C)检查对PTSD患者进行分析。结果北川羌族与绵阳郊区RA活动组患者(分别为58例、39例)与健康对照组比较,CD8+T淋巴细胞数降低,CD+4/CD8+比值增高,差异有统计学意义(P<0.05);北川羌族RA活动组与绵阳郊区RA活动组比较,CD3+T淋巴细胞数降低,差异有统计学意义(P<0.05)。北川RA患者中PTSD者(38例)与非PTSD者(60例)比较,PTSD组CD3+T淋巴细胞数和CD4+/CD+8比值均明显低于PTSD组,差异有统计学意义(P<0.05);PCL-C对北川RA患者中PTSD的测定发现,PCL高分组CD3+T淋巴细胞数显著低于PCL低分组(P<0.05)。结论 “5.12”地震后一部分RA患者出现T细胞免疫功能异常,且免疫功能异常与PTSD有关,对合并有PTSD的进行RA患者早期心理干预及药物治疗,改善患者生存质量。
Objective To investigate the expression of T lymphocyte subsets in peripheral blood of patients with rheumatoid arthritis (RA) in Beichuan area after the 5.12 earthquake and to analyze the influence of posttraumatic stress disorder (PTSD) on cellular immunity in RA patients. Methods From March 2009 to March 2010, 98 healthy subjects with RA in Beichuan and 112 healthy controls were enrolled, and 84 RA patients in suburban Mianyang and 120 healthy controls were analyzed. The numbers of CD3 +, CD3 + CD4 +, CD3 + CD8 + T lymphocytes and the ratio of CD4 / + CD8 + were detected by flow cytometry. The activity of RA was measured by DAS28. According to the American Diagnostic and Statistical Manual of Mental Disorders, IV) Diagnostic criteria PTSD patients in the RA population were surveyed and PTSD patients were analyzed using the PTSD Checklist (PCL-C) test. Results Compared with healthy control group, the number of CD8 + T lymphocytes and the ratio of CD + 4 / CD8 + in RA activity group of Beichuan and Mianyang suburb were significantly higher than those in control group (P <0.05) ); The number of CD3 + T lymphocytes in Beichuan Qiang RA group was lower than that in RA group in Mianyang suburb, the difference was statistically significant (P <0.05). Compared with PTSD group (38 cases) and non-PTSD group (60 cases), the ratio of CD3 + T lymphocyte and CD4 + / CD + 8 in PTSD group was significantly lower than that in PTSD group (P < 0.05). The results of PCL-C on PTSD in patients with RA in Beichuan showed that the number of CD3 + T lymphocytes in PCL high score group was significantly lower than that in PCL low score group (P <0.05). Conclusion Some RA patients with RA after the “5.12” earthquake have abnormal immune function of T cells, and the immune dysfunction is related to PTSD. Early psychological intervention and drug treatment are performed in RA patients with PTSD, so as to improve the quality of life of patients.