Addition of Fibroblast-Stromal Cell Markers to Immune Synovium Pathotypes Better Predicts Radiographic Progression at 1 Year in Active Rheumatoid Arthritis.
Addition of Fibroblast-Stromal Cell Markers to Immune Synovium Pathotypes Better Predicts Radiographic Progression at 1 Year in Active Rheumatoid Arthritis.
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将成纤维细胞-基质细胞标记物添加到免疫滑膜病理型中可以更好地预测活动性类风湿关节炎 1 年时的影像学进展
DOI：
10.3389/fimmu.2021.778480
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发表时间：
2021
影响因子：
7.3
通讯作者：
Dai L
中科院分区：
文献类型：
--
作者：
Zhang XP;Ma JD;Mo YQ;Jing J;Zheng DH;Chen LF;Wu T;Chen CT;Zhang Q;Zou YY;Lin JZ;Xu YH;Zou YW;Yang ZH;Ling L;Miossec P;Dai L
目的本研究旨在探讨是否加入成纤维细胞基质细胞标志物的滑膜病理类型的分类提高其对类风湿关节炎（RA）的临床结果的预测价值。方法从真实世界前瞻性队列中招募基线和完成1年随访时进行膝关节穿刺滑膜活检的活动性RA患者。对CD 20、CD 38、CD 3、CD 68、CD 31和CD 90的阳性染色进行半定量评分（0-4）。主要结局是放射学进展，定义为从基线至1年，改良的Sharp总分至少增加0.5个单位。结果150例RA患者中，123例（82%）滑膜组织合格。CD 20 + B细胞、亚层CD 68+巨噬细胞、CD 31+内皮细胞和CD 90+成纤维细胞的评分越高，疾病活动性降低越少，放射学进展增加越多。一种新的基于成纤维细胞的滑膜病理类型分类，优先考虑骨髓和基质细胞，将样本分为骨髓基质（57.7%，71/123），淋巴（31.7%，39/123）和少细胞病理类型（10.6%，13/123）。骨髓间质病理型RA患者在3、6和12个月时放射学进展率最高（43.7% vs. 23.1% vs. 7.7%，p = 0.011），布尔缓解率最低。基线滑膜骨髓间质病理类型独立预测1年时的放射学进展（校正OR：3.199，95%置信区间（95% CI）：1.278，8.010）。在初治RA的亚组分析中获得了类似的结果。结论这种新的以成纤维细胞为基础的骨髓间质病理类型可以预测活动性RA患者1年时的放射学进展，这可能有助于RA治疗决策的转变。
Objectives This study aims to investigate if addition of fibroblast-stromal cell markers to a classification of synovial pathotypes improves their predictive value on clinical outcomes in rheumatoid arthritis (RA). Methods Active RA patients with a knee needle synovial biopsy at baseline and finished 1-year follow-up were recruited from a real-world prospective cohort. Positive staining for CD20, CD38, CD3, CD68, CD31, and CD90 were scored semiquantitatively (0-4). The primary outcome was radiographic progression defined as a minimum increase of 0.5 units of the modified total Sharp score from baseline to 1 year. Results Among 150 recruited RA patients, 123 (82%) had qualified synovial tissue. Higher scores of CD20+ B cells, sublining CD68+ macrophages, CD31+ endothelial cells, and CD90+ fibroblasts were associated with less decrease in disease activity and greater increase in radiographic progression. A new fibroblast-based classification of synovial pathotypes giving more priority to myeloid and stromal cells classified samples as myeloid-stromal (57.7%, 71/123), lymphoid (31.7%, 39/123), and paucicellular pathotypes (10.6%, 13/123). RA patients with myeloid-stromal pathotype showed the highest rate of radiographic progression (43.7% vs. 23.1% vs. 7.7%, p = 0.011), together with the lowest rate of Boolean remission at 3, 6, and 12 months. Baseline synovial myeloid-stromal pathotype independently predicted radiographic progression at 1 year (adjusted OR: 3.199, 95% confidence interval (95% CI): 1.278, 8.010). Similar results were obtained in a subgroup analysis of treatment-naive RA. Conclusions This novel fibroblast-based myeloid-stromal pathotype could predict radiographic progression at 1 year in active RA patients which may contribute to the shift of therapeutic decision in RA.
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影响因子：
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影响因子：
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作者：
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影响因子：
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