类风湿关节炎患者中医证型特点与Th17/Treg平衡和疾病活动度的关系

Relationship between TCM syndrome type and Th17/Treg balance and disease activity in patients with rheumatoid arthritis

目的:探讨类风湿关节炎(RA)患者中医证型特点及与辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡和疾病活动度的关系。方法:以2022年3月~2024年2月217例RA患者作为病例组,并选取同期健康体检志愿者100名为对照组,比较两组Th17细胞、Treg细胞、Th17/Treg及其相关因子[白细胞介素-17(IL-17)、IL-23]水平。依据中医证型将患者分为湿热痹阻证(108例)、寒湿痹阻证(43例)、痰瘀痹阻证(35例)、肝肾亏虚证(31例),比较各组患者临床特征分布情况、Th17/Treg及其相关因子、28个疾病活动度(DAS28)。结果:病例组Th17细胞、Th17/Treg及其相关因子水平高于对照组,Treg细胞低于对照组(P<0.05)。4种中医证型RA患者关节肿胀数、关节压痛数计病程存在显著差异(P<0.05);4种中医证型RA患者Treg、Th17细胞水平、Th17/Treg、IL-17、IL-23及DAS28水平存在显著差异(P<0.05)。4种证型RA患者DAS28评分等级差异具有统计学意义(P<0.05);其中湿热痹阻证、寒湿痹阻证RA患者高疾病活动度占比最高,痰瘀痹阻证、肝肾亏虚证RA患者中疾病活动度占比最高。结论:不同中医证型的RA患者外周血存在Th17/Treg细胞失衡,同时Th17/Treg细胞相关因子也表达异常;不同的中医证型患者间活动度存在明显的差异;RA患者的中医证型与Th17/Treg平衡和疾病活动度有关。

Objective:To investigate the characteristics of traditional Chinese medicine syndrome in patients with rheumatoid arthritis(RA)and the relationship between helper T cell 17(Th17)/regulatory T cell(Treg)balance and disease activity.Methods:From March 2022 to February 2024,217 patients with RA were selected as the case group,and 100 healthy volunteers were selected as the control group.The levels of Th17 cells,Treg cells,Th17/Treg and their related factors[IL-17,IL-23]were compared between the two groups.The patients were divided into damp-heat syndrome(108 cases),cold-dampness syndrome(43 cases),phlegm-blood stasis syndrome(35 cases)and deficiency of liver and kidney syndrome(31 cases)according to TCM syndrome type,the distribution of clinical characteristics,Th17/Treg and its related factors,28 disease activity(Das28)were compared among the groups.Results:The levels of Th17 cells,Th17/Treg and their related factors in case group were higher than those in control group,while the levels of Treg cells in case group were lower than those in control group(P<0.05).There were significant differences in the number of swelling and tenderness of joints between the 4 types of RA(P<0.05).The levels of Treg,Th17 cells,Th17/Treg,IL-17,IL-23 and Das28 were significantly different among the 4 types of RA(P<0.05).There were significant differences in Das28 scores among the 4 types of RA(P<0.05),and the patients with damp-heat syndrome and cold-dampness syndrome had the highest disease activity,the disease activity of RA patients with phlegm-blood stasis syndrome and deficiency of liver and kidney syndrome was the highest.Conclusion:There is Th17/Treg cell imbalance and abnormal expression of Th17/Treg cell related factors in peripheral blood of RA patients with different TCM syndrome types.There were significant differences in activity among patients with different TCM syndrome types.The TCM syndrome type of RA patients is related to Th17/Treg balance and disease activity.