Presence of hepatitis B virus in synovium and its clinical significance in rheumatoid arthritis.
Presence of hepatitis B virus in synovium and its clinical significance in rheumatoid arthritis.
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类风湿性关节炎滑膜中乙型肝炎病毒的存在及其临床意义
DOI：
10.1186/s13075-018-1623-y
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发表时间：
2018-06-19
影响因子：
4.9
通讯作者：
Dai L
中科院分区：
文献类型：
--
作者：
Chen YL;Jing J;Mo YQ;Ma JD;Yang LJ;Chen LF;Zhang X;Yan T;Zheng DH;Pessler F;Dai L
既往研究发现乙型肝炎病毒（HBV）感染可能与类风湿关节炎（RA）有关，但尚未见类风湿关节炎合并HBV感染患者滑膜中是否存在HBV抗原或核酸的研究。在本研究中，我们探讨了乙肝病毒在滑膜中的存在及其在RA中的临床意义。从前瞻性队列中招募了57名连续的活动性RA患者（疾病活动性评分28-关节评估基于c反应蛋白≥2.6）和可用滑膜组织，这些患者完成了1年的随访。根据基线HBV感染情况将患者分为慢性HBV感染组（CHB, n = 11）和非慢性HBV感染组。临床资料收集于基线和1、3、6、12个月的随访。采用Sharp/van der Heijde-modified Sharp评分（mTSS）评估基线和第12个月时手/手腕的影像学变化。采用乙肝病毒表面抗原和乙肝病毒核心抗原（HBcAg）的免疫组化染色和HBV S基因的巢式PCR检测滑膜中的HBV。在RA合并CHB患者的滑膜中发现HBcAg(7 / 11, 64%)，通过PCR检测HBV S基因证实。与非CHB组比较，CHB组滑膜内cd68阳性巨噬细胞、cd20阳性B细胞、cd15阳性中性粒细胞浸润较多（均p < 0.05）。与基线相比，大多数疾病活动性指标的改善较小，主要在第12个月，CHB患者经历1年放射学进展的比例显著增加（ΔmTSS≥0.5单位/年，64%对26%，p = 0.024）。多因素logistic回归分析显示CHB状态（OR 14.230, 95% CI 2.213-95.388; p = 0.006）和滑膜cd68阳性巨噬细胞密度（OR 1.002, 95% CI 1.001-1.003; p = 0.003）与1年影像学进展独立相关。RA滑膜中HBV的存在可能参与局部病变的发病机制并加剧RA的疾病进展。本文的在线版本（10.1186/s13075-018-1623-y）包含补充材料，授权用户可以使用。
Previous studies have revealed that hepatitis B virus (HBV) infection may be related to rheumatoid arthritis (RA), but there are no studies on the presence of HBV antigens or nucleic acid in synovium from patients with RA with HBV infection. In the present study, we investigated the presence of HBV in the synovium and its clinical significance in RA. Fifty-seven consecutive patients with active RA (Disease Activity Score 28-joint assessment based on C-reactive protein ≥ 2.6) and available synovial tissue who had completed 1 year of follow-up were recruited from a prospective cohort. The patients were divided into chronic HBV infection (CHB, n = 11) and non-CHB groups according to baseline HBV infection status. Clinical data were collected at baseline and at 1-, 3-, 6-, and 12-month follow-up. Radiographic changes of hand/wrist at baseline and month 12 were assessed with the Sharp/van der Heijde-modified Sharp score (mTSS). HBV in synovium was determined by immunohistochemical staining for hepatitis B virus surface antigen and hepatitis B virus core antigen (HBcAg) and by nested PCR for the HBV S gene. HBcAg was found in the synovium of patients with RA with CHB (7 of 11, 64%), which was confirmed by PCR for the HBV S gene. Compared with the non-CHB group, more CD68-positive macrophages, CD20-positive B cells, and CD15-positive neutrophils infiltrated the synovium in the CHB group (all p < 0.05). There were smaller improvements from baseline in most disease activity indicators mainly at month 12, and a significantly higher percentage of CHB patients experienced 1-year radiographic progression (ΔmTSS ≥ 0.5 unit/yr, 64% vs. 26%, p = 0.024). Multivariate logistic regression analysis showed that CHB status (OR 14.230, 95% CI 2.213–95.388; p = 0.006) and the density of synovial CD68-positive macrophages (OR 1.002, 95% CI 1.001–1.003; p = 0.003) were independently associated with 1-year radiographic progression. The presence of HBV in RA synovium may be involved in the pathogenesis of local lesions and exacerbate disease progression in RA. The online version of this article (10.1186/s13075-018-1623-y) contains supplementary material, which is available to authorized users.
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影响因子：
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影响因子：
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影响因子：
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