| Background:Rheumatoid arthritis(RA)is a systemic autoimmune disease characterized by persistent synovitis,cartilage damage and bone erosion.The incidence rate of China is about 0.36%,which is a highly disabling disease [1].Rheumatoid factor(RF)and anti citrullinated protein antibody(acpas)have been used as biomarkers of rheumatoid arthritis.Whether ACPA is often based on anti cyclic citrullinated peptide antibody(ACPA)or not is often used as a biomarker of rheumatoid arthritis Antibody(anti CCP antibody)was detected.The detection of acpas in serum and synovial fluid of RA patients has become an internationally recognized specific and sensitive index for early diagnosis of RA and judgment of joint injury.At present,there are many reports about anti cyclic citrullinated peptide(CCP),anti mutated citrullinated vimentin(MCV)and anti perinuclear factor(anti perinuclear)Factor,APF),anti keratin antibodies(aka)[3].Although we can detect acpas and RF in most RA patients,there are still 25% RA patients with negative ACPA and RF.In addition,some patients were only RF or acpas positive [4].Clinically,RA is often divided into serum negative rheumatoid arthritis(snra)and serum positive rheumatoid arthritis(spra)according to the presence or absence of RF and ACPA [3].It has been reported that when RF and acpas exist at the same time,RA patients may have more severe inflammatory reaction and higher disease activity [5].At present,there are no studies on the comparison of lymphocyte subsets,CD4 + T cell subsets and cytokines between snra and spra.The purpose of this study is to analyze the differences of lymphocyte subsets,CD4 + T cell subsets and cytokines between snra and spra,and to compare the influence of ACPA and RF on the distribution of immune cell phenotype in RA and the disease.Objective:Objective to investigate the difference of lymphocyte subsets,CD4 + T cell subsets and cytokine expression between RA patients with positive serum antibody and RA patients with negative serum antibody.Methods:A total of 111 patients with RA admitted to the Department of Rheumatology and immunology,the second hospital of Shanxi Medical University from January 2020 to October 2020 were collected.According to the presence of RF and ACPA,they were divided into RA patients with positive serum antibody and RA patients with negative serum antibody.Anti CCP antibody,anti MCV antibody,anti perinuclear factor(APF)and anti keratin antibody(aka)were used as the criteria to judge whether ACPA was positive or negative.If anti CCP antibody > 20 U / ml or anti MCV antibody > 20 U / ml or anti perinuclear factor(APF)> 1:20 or anti keratin antibody(aka)> 1:10,ACPA was positive;if the above four antibodies were negative,ACPA was negative.ACPA positive and RF positive were serum antibody positive RA(spra),ACPA negative and RF negative were serum antibody negative RA(snra).The absolute counts of lymphocyte subsets and CD4 + T cell subsets in peripheral blood of the two groups were detected by flow cytometry,and the levels of interleukin(IL)-2,-4,-6,-10,-17,interferon-γ and tumor necrosis factor-α in plasma of the two groups were detected by flow cytometry.The differences of lymphocyte subsets,CD4 + T cell subsets and cytokines between the two groups were analyzed.Mann Whitney U test and Kruskal Wallis h test were used for statistical analysis.Results:Among 111 patients with RA,70(63.1%)were in spra group and 41(36.9%)were in snra group.(1)Erythrocyte sedimentation rate(ESR)[65.76(33.00,13.50)] in spra group was significantly higher than that in snra Group [32.85(12.50,51.50)],DAS28 score [14.36(11.53,16.35)] in spra group was higher than that in snra Group [10.11(7.61,12.83)],both of which were statistically significant(P < 0.001);(2)the concentrations of complement and immunoglobulin in spra group were higher than those in snra group,and complement C4 [0.27(0.20,16.35)] in spra group was higher than that in snra group,Compared with snra Group [0.19(9.52,14.35)],the Ig A concentration in spra Group [4.04(2.50,4.76)] was higher than that in snra Group [2.93(2.11,3.46)],and the Ig A concentration in spra Group [1.50(1.00,1.86)] was higher than that in snra Group [1.22(1.02,1.02,1.06)],(3)the cytokines(IL-2,4,6,10,17,IFN-γ,TNF-α)in the spra group were higher than those in the snra group,and the differences were statistically significant;(4)the absolute counts of total T cells,B cells,NK cells,CD4 + T cells and CD8 + T cells in the spra group were higher than those in the snra group,and the NK cells in the spra Group [290.89(173.67,(5)Treg cells in spra Group [17.14(10.54,22.77)] were lower than those in snra Group [26.56(17.60,22.77)],The ratios of Th17 cells,Th17 / Treg,Th1 / Treg,Th2 / Treg,B / Treg and NK / Treg in spra group were higher than those in snra group(P < 0.05).Conclusion:There were significant differences in peripheral blood lymphocyte subsets,CD4 + T cell subsets and cytokines between spra group and snra group,and RA patients in spra group showed more serious immune cell imbalance,high levels of cytokines and severe bone erosion and bone destruction,which indicated that RF and ACPA played an important role in the occurrence and development of RA. |
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