类风湿关节炎患者中医体质分布及miR-146a表达

Chinese Medical Constitution and Expression of miR-146a in Rheumatoid Arthritis Patients

目的分析类风湿关节炎(RA)患者中医体质类型分布,探讨RA患者常见中医体质类型与RA外周血单个核细胞(PBMC)中miR-146a的表达及RA患者病情活动与临床特点之间的关系。方法纳入2015年11月—2017年10月在深圳市龙华区人民医院风湿免疫科门诊就诊或住院的RA患者186例,其中活动期97例,非活动期89例。对RA患者进行中医体质类型判定,比较不同性别RA患者之间的中医体质分布差异;比较活动期、非活动期、有关节外表现及无关节外表现RA患者体质分布。同时采用实时荧光定量的聚合酶链反应(PCR)方法,检测RA患者PBMC中miR-146a的表达水平。计算RA患者DAS28评分。结果 186例RA患者中阳虚质57例(30.6%)、瘀血质33例(17.7%)、湿热质19例(10.2%)、痰湿质20例(10.8%)、气虚质15例(8.1%)、阴虚质12例(6.5%)、特禀质11例(5.9%)、气郁质10例(5.4%)、平和质9例(4.8%)。女性RA患者中瘀血质的比例[21.1%(32/152)]显著高于男性RA患者[5.9%(1/34),P<0.05]。阳虚质RA患者的PBMC中miR-146a的表达及DAS28评分均显著高于平和质RA患者(P<0.05)。活动期RA患者中阳虚质的比例显著高于非活动期RA患者(P<0.05),而活动期RA患者中平和质RA患者的比例显著低于非活动期RA患者(P<0.05)。有关节外表现RA患者中阳虚质的比例显著高于无关节外表现RA患者(P<0.01),而有关节外表现RA患者中平和质RA患者的比例显著低于无关节外表现RA患者(P<0.01)。结论 RA患者中阳虚质中医体质最为多见,不同性别RA患者的中医体质类型比例存在差异,中医体质可能与RA患者PBMC中miR-146a的表达、病情活动度及特定临床表现存在相关。

Objective To investigate the relationship between the expression of miR-146a in peripheral blood mononuclear cells(PBMCs)and types of Chinese medical constitutions(CMC)and clinical manifestations in rheumatoid arthritis(RA).Methods A total of 186 outpatients and inpatients in the department of rheumatology,People′s Hospital of Longhua District Shenzhen from November 2015 to October 2017 were recruited,including 97 active RA patients and 89 stable RA patients.All RA patients were classified into different types of CMC.The differences of CMC distribution among RA patients of different genders were compared.The constitution distribution of patients with active phase,stable phase,extraarticular manifestations and without extraarticular manifestations were compared.The expression level of miR-146a in PBMC was detected by real-time PCR method.The DAS28 scores were also calculated.Results The number of patients with Yang-deficiency constitution,blood-stasis constitution,damp-heat constitution,phlegm-dampness constitution,Qi-deficiency constitution,Yin-deficiency constitution,special constitution,Qi-stagnation constitution,Yin-Yang harmony constitution was 57(30.6%),33(17.7%),19(10.2%),20(10.8%),15(8.1%),12(6.5%),11(5.9%),10(5.4%),9(4.8%),respectively in total 186 RA patients.The percent of constitution of blood-stasis was higher in female patients than in male patients(21.1%(32/152)vs.5.9%(1/34),P<0.05)The expression of miR-146a in PBMCs and DAS28 score were both higher in Yang-deficiency patients than in Yin-Yang harmony patients(P<0.01).The percent of Yang-deficiency constitution was higher in active RA patients than in stable RA patients,while the percent of Yin-Yang harmony constitution was lower(P<0.01).The percent of Yang-deficiency was higher in RA patients with extraarticular manifestations than in RA patients without extraarticular manifestations,meanwhile the percent of Yin-Yang harmony constitution was lower(P<0.01).Conclusion The most common CMC in RA patients was Yang-deficiency constitution and that CMC type in male was different from which in female,and CMC may correlated with the expression of miR-146a and disease activity and the clinical manifestations in RA.