目的:皮肌炎(DM)与感染密切相关,在合并EB病毒(EBV)/巨细胞病毒(CMV)感染的DM患者中,很少对外周血淋巴细胞亚群水平进行研究.这里,我们的目的是观察淋巴细胞亚群的水平,尤其是Th17,调节性T(Treg)细胞在DM合并EBV/CMV病毒血症,并探讨短期低剂量IL-2的作用。
方法:34例DM合并EBV/CMV病毒血症患者(DM感染组),我们的研究纳入了31例未感染的DM患者(DM非感染组)和20例健康对照。在DM感染组中,13名患者在常规治疗的基础上接受50万IU/天的低剂量IL-2,为期5天。一切受试者均完成了流式细胞术检测外周血淋巴细胞亚群的绝对数目。
结果:感染组总T水平显著下降,总计B,NK,CD4+T细胞及CD4+T亚群(Th1、Th2、Th17、Treg细胞)。与健康对照相比,感染组Th17细胞显著减少,但非感染组(P<0.001vs.P=0.171)。低剂量IL-2治疗后,Treg(P=0.001)细胞和Th17细胞水平显著升高,重新平衡Th17和Treg比例。
结论:合并EBV/CMV病毒血症的DM患者中Th17和Treg细胞的绝对数量进一步减少。除了Treg细胞,Th17细胞的减少也可能是一个关键特征。低剂量IL-2治疗可能是有益和安全的免疫调节治疗,以恢复这些患者Th17和Treg细胞之间的失衡。低剂量IL-2治疗可能是一个新的前景领域,具有一些挑战,例如在各种病毒感染中的长期免疫调节作用。
OBJECTIVE: Dermatomyositis (DM) is closely associated with infection, the levels of peripheral lymphocyte subpopulations are rarely studied in patients with DM combined with Epstein-Barr virus (EBV)/cytomegalovirus (CMV) infection. Here, we aimed to observe the level of lymphocyte subsets, especially Th17, regulatory T (Treg) cells in DM combined with EBV/CMV viremia, and explore the effects of short-term low-dose IL-2.
METHODS: 34 DM patients combined with EBV/CMV viremia (DM infection group), 31 DM patients without infection (DM non-infection group) and 20 healthy controls were entrolled in our study. In DM infection group, 13 patients received low-dose IL-2 at 0.50 Million IU/day for a five-day course on the basis of conventional treatment. All subjects had completed the decetion of the absolute numbers of lymphocytes subsets in peripheral blood by flow cytometry.
RESULTS: The infection group had significant decreases levels of total T, total B, NK, CD4 + T cells and CD4 + T subsets (Th1, Th2, Th17, Treg cells). Compare to the healthy controls, Th17 cells was significantly reduced in the infection group, but not in the non-infection group (P < 0.001 vs. P = 0.171). After low-dose IL-2 therapy, the levels of Treg (P = 0.001) cells and Th17 cells were significantly elevated, re-balancing the Th17 and Treg proportions.
CONCLUSIONS: The absolute numbers of Th17 and Treg cells in DM patients with EBV/CMV viremia is further reduced. In addition to Treg cells, a decrease in Th17 cells may be also a crucial feature. Low-dose IL-2 treatment may be beneficial and safe prospect immunomodulatory therapy to restores imbalance between Th17 and Treg cells for these patients. Low-dose IL-2 therapy may be a new prospect field with some challenges such as long-term immunoregulatory utility in various virus infection.