| Objective: Rheumatoid arthritis(RA)is a kind of chronic systemic autoimmune disease with the chronic joints inflammation.Joint injury and dysfunction are the majorly adverse outcomes of RA,resulting in lower the quality of life and shortened life expectancy.In addition,RA may damage other systems,such as respiratory system and cardiovascular system.In the process of the whole treatment,the patient’s condition and the degree of disease activity should be monitored closely,and the reasonable treatment plan should be made according to the change of the disease.More laboratory indicators are needed to more accurately assess the degree of disease activity in RA.Until now,the pathogenic mechanism of RA is still unclear.At present,it is considered that it is a kind of antigen driven,genetic correlation and multiple factors involve in autoimmune disease.The study shows that the innate immune system plays an important role in the pathogenesis of RA,especially the complement system.The innate immune system can recognize pathogen associated molecular patterns by pattern recognition receptors,through the pathogen of phagocytosis,conditioning,presentation,and then activate adaptive immunity.Ficolins are a group of proteins that can identify and combine with the pathogen associated molecular patterns,and thus initiate the complement lectin pathway(MBL pathway),promote the pathogen opsonization,in addition to involve in the death of host cells and cell debris removal,play a very important role in innate defense.At present,there are three kinds of ficolins(M-ficolin,H-ficolin and L-ficolin)in the peripheral blood of normal group,some studies suggest that ficolins play an important role in the pathogenesis of rheumatoid arthritis.The aim of this study was to investigate the levels of peripheral blood plasma M-ficolin,L-ficolin and their correlation with disease activity and clinical indexes in patients with rheumatoid arthritis(RA),to explore their role in pathogenesis of RA.Methods: 61 cases of RA patients who come from the department of Rheumatology of the Third Hospital of Hebei Medical University were collected during January 2015 to September 2015.RA patients were consistent with the American College of Rheumatology(ACR)and the European Union of resistance Rheumatism(EULAR)RA classification standard revised in 2010.18 healthy people from the Health Examination Center of Hebei Medical University were selected as the healthy control group.According to the disease activity(DAS28),61 RA patients who were grouped into low(n=19)、moderate(n=19)、high(n=23)disease activity groups.The clinical datum of RA patients were recorded like gender,age,course,the number of tender joints,the number of swollen joints,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),the number of white blood cell(WBC),neutrophile(NEUT),monocyte(MONO),the blood platele(PLT),and calculated the 28-joint disease activity scale(DAS28).M-ficolin,L-ficolin levels of 61 RA patients who were grouped according to the disease activity and 18 healthy controls were detected by enzyme-linked immunosorbent assay(ELISA).Compare the levels of M-ficolin,L-ficolin in RA patients with healthy group,to find the difference between the two groups.The relationships between the levels of M-ficolin,L-ficolin and laboratory parameters,disease activity were investigated in RA patients.All the data were analyzed by statistical software SPSS17.0 for windows.The mean number ± standard deviation(x ±s)was used to express the measurement data of the normal distribution.The t test or t’ test was used for the comparison of two groups.The comparison of measurement data between multiple groups was analyzed by using the method of variance analysis,and the L-S-D method was used the further comparison.The median and interquartile range(M QR)was used to express the measurement data which do not conform the normal distribution.Wilcoxcon test was adopted to comparison between groups which do not conform normality.Kruskal-Wallis H test was used to comparison of more than three groups.The correlation of parameters were tested by linear correlation analysis.P value<0.05 was considered statistically significant.Results: 1 The description of the basic data: The RA group comprised 61 patients,including 6 cases of male,55 cases of female,the mean age was(47±12)years old,the course of the disease was from 2 month to 20 years,with median duration of 3 years.According to the disease activity,61 RA patients were grouped low(n=19)、 moderate(n=19)、 high(n=23)disease activity groups.The low disease activity group(DAS28≤3.2 n=19)included 2 cases of male and 17 cases of female,the average age was(47±14)years old,the course of the disease was from 4 month to 20 years,with median duration of 3 years;the moderate disease activity group(3.2<DAS28≤5.1 n=19)contained 0 cases of male and 19 cases of female,the average age was(44±11)years old,the course of the disease was from 2 month to 11 years,with median duration of 2 years;the high disease activity group(DAS28>5.1 n=23)contained 4 cases of male and 19 cases of female,the average age was(51±11)years old,the course of the disease was from 4 month to 20 years,with median duration of 2 years.The healthy group comprised 4 subjects were male,14 subjects were female,the average age was(45±9)years old.There were no differences between the patients and healthy subjects in age,gender(P>0.05).There were no differences in three groups in age,gender(P>0.05).The ESR、CRP、DAS28、RF、WBC、NEUT、MONO and PLT of 61 RA patients were(M51.98mm/h QR51mm/h),(M28.29mg/L QR33.05mg/L),(M4.69 QR2.84),(M306.80IU/ml QR341.25IU/ml),(7.15±1.86)×10~9/L,(M4.35×10~9/L QR2.17×10~9/L),(M0.45×10~9/L QR0.26×10~9/L),(279.70±67.51)×106/L.2 The levels of peripheral blood plasma M-ficolin,L-ficolin in RA and healthy group: The levels of peripheral blood plasma M-ficolin in 61 RA patients were(M39.72ng/mL QR23.74ng/mL),which were significantly higher than healthy group(14.40±3.71)ng/mL(Z=-5.72,P<0.05),the difference was statistically significant.The levels of peripheral blood plasma L-ficolin in 61 RA patients were(1.72±0.64)ug/mL,which were significantly higher than healthy group(1.31±0.47)ug/mL(t=2.55,P<0.05),the difference was statistically significant.3 M-ficolin,L-ficolin levels of 61 RA patients in low,moderate and high disease activity: M-ficolin levels in low,moderate and high disease activity were(20.80±5.16)ng/mL,(M35.42ng/mL QR13.28ng/mL),(M49.66 ng/mL QR24.66ng/mL),there was significant difference among the three groups(P<0.01),the difference was statistically significant;the L-ficolin levels in low,moderate and high disease activity group were(1.24±0.54)ug/mL,(1.67±0.40)ug/mL,(2.16±0.59)ug/mL,there was significant difference among the three groups(P<0.05),the difference was statistically significant.4 The correlation between M-ficolin,L-ficolin levels of 61 RA patients and clinical indexes: according to correlation analysis,the levels of M-ficolin in plasma were significantly positive correlation with DAS28(r=0.830,P=0.000),ESR(r=0.692,P=0.000),CRP(r=0.725,P=0.000),,WBC(r=0.388,P=0.002),NEUT(r=0.397,P=0.002),MONO(r=0.338,P=0.008),PLT(r=0.476,P=0.000);the levels of L-ficolin in plasma were significantly positive correlation with DAS28(r=0.653,P=0.000),ESR(r=0.593,P=0.000),CRP(r=0.630,P=0.000),WBC(r=0.254,P=0.048),NEUT(r=0.302,P=0.007),MONO(r=0.312,P=0.014),PLT(r=0.340,P=0.000).Removing the four RF-negative patients from 61 RA patients,M-ficolin,L-ficolin levels of 57 RA patients in plasma were significantly positive correlation with RF(r=0.600,P=0.000),RF(r=0.363,P=0.006).Conclusions:1 The levels of peripheral blood plasma M-ficolin,L-ficolin in RA were significantly higher than healthy group,which suggested that M-ficolin,L-ficolin may play an important role in the pathogenesis of RA.2 The levels of peripheral blood plasma M-ficolin,L-ficolin were positively correlated with the laboratory parameters of disease activity.This leaves M-ficolin,L-ficolin as potential new biomarkers for disease activity in patients with RA.3 The levels of peripheral blood plasma M-ficolin were positively correlated with WBC,NEUT,MONO,PLT. |
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