Expression Difference And Significance Of TNF-α、IFN-γ、IL-17、IL-6、IL-10 And IP-10 In Juvenile Idiopathic Arthritis Peripheral Blood

ObjectiveDetecting the level of Th1/Th2, Th17/Treg related cytokines and chemokine(IP-10) in the peripheral blood of JIA patients, to analyze the relationship between cytokines with disease activity, duration and biological agents, ect, in order to discuss the function and clinical significance of Th1, Th2, Th17, Treg cells and chemokine in JIA.MethodCollecting 61 JIA patients from Department of Nephrology and Immunology, Children’s Hospital of Chongqing Medical University during November 2013 to August 2015, which were diagnosed and classified from JIA standard of ILAR in 2001. According to DAS28 score, all patients were divided into four groups, including highly activity(4 patients), moderate activity(9 patients), low activity(27 patients) and inactivity(21 patients); Total activity group including poliarticular course JIA(pJIA)(7 patients) and systemic JIA(sJIA)(33 patients), inactivity group including poliarticular course JIA(pJIA)(10 patients) and systemic JIA(s JIA)(11 patients); 26 patients of the 61 patients for the first time to use of biological agents. Finally, 14 patients have a regular followed-up. We collect the peripheral blood of JIA patients and detecte the cytokines by enzyme-linked immunoabsorbent assays(ELISA).Results1.The cytokines expression level with disease activity: We have found that ESR was positively correlated with disease activity indexes DAS28 in JIA patients(P<0.01); The level of TNF-α, IFN-γ, IL-17 and IL-6 were significantly positively correlated with DAS28(P<0.01), IL-10 was negatively correlated with DAS28(P<0.01). The correlation between IP-10 and DAS28 was weakly negative(P<0.01). TNF-α was strong positively correlated with IFN-γ(P<0.01). IL-6 was strong positively correlated with IL-17(P<0.01). IL-10 was negatively correlated with TNF-α, IL-6 and IL-17(P<0.01). IP-10 was weakly negative correlated with IL-17(P<0.01). The activity groups of TNF-α, IFN-γ, IL-17 and IL-6 level were significantly higher than the inactivity group(P<0.05), the activity groups of IL-10 level was significantly lower than the inactivity group(P<0.05), the IP-10 level was not significantly between the activity group and the inactivity group(P>0.05).2.The cytokines expression level with different types of JIA: the positive correlation exist between IL-6 and IL-17 in sJIA group(P<0.01), the negative correlation exist between IP-10 and IL-17 in pJIA group(P<0.05). IL-17 and IL-6 level in sJIA group were higher than pJIA group(P<0.05). TNF-α and IP-10 level in pJIA group were higher than sJIA group(P<0.05). IFN-γ and IL-10 level have no significant difference between pJIA group and sJIA group(P>0.05).3.Biological agents impacting on cytokines levels: DAS28 decreased significantly after biological agents(P<0.05). TNF-α, IFN-γ, IL-17 and IL-6 levels decreased significantly in different degrees after biological agents(P<0.05). IL-10 increased significantly after biological agents(P<0.05). TNF-α, IFN-γ, IL-17 and IL-6 in follow-up group stay lower levels.Conclusion1.Expression level of Th1 and Th17 related cytokines in active stage have an advantage than Th2 and Treg, with the remission of the disease, Th2 and Treg related cytokines gradually became an advantage.2.Th1 related cytokines and chemokine(IP-10) higher expression in pJIA, Th17 related cytokines(IL-17) higher expression in sJIA.3.Biological agents improve JIA patients’ disease activity by effecting Th1/Th2 and Th17/Treg cell subsets balance. Biologics will make DAS28 values lower, make Th1, Th17 lower and make Th2, Treg higher, to regulation of Th1/Th2 and Th17/Treg cell subsets balance.