| Objective:1.To compare the differences of the count of lymphocyte subtypes in peripheral blood of patients with SLE and healthy controls.2.To analyze the correlation between the count of Th17 cells,Treg cells and disease duration,SLEDAI score,ESR in patients with SLE.3.To compare the changes of the count of Th17 cells,Treg cells and the ratio of Th17 cells to Treg cells in peripheral blood of patients with SLE before and after the treatment in ATRA+RAPA group and RAPA group respectively.4.To observe the changes of SLEDAI scores,ESR and hormone usage before and after the treatment in the two groups,and compare the differences of curative effect between the two groups.Methods:A total of 120 subjects were included in this study,including 60 patients with SLE(58 women and 2 men,mean age of 35.77±9.90 years),all of whom were from outpatient and inpatient department of rheumatology in our hospital.And sixty gender and age matched healthy control group(57 women and 3 men,mean age of 33.58±9.93years),from our medical examination center,medical staff and other healthy blood donors.Flow Cytometry was used to detect the count of lymphocyte subtypes in peripheral blood of 120 subjects,analyze the differences of the count of lymphocyte subtypes between SLE patients and healthy controls.Secondly,analyze the correlation between the count of Th17 cells,Treg cells and duration of disease,SLEDAI scores,ESR in peripheral blood of SLE patients.Randomized SLE patients into two groups,one group was treated with ATRA(10mg/times,twice a week)+RAPA(0.5mg/times,twice a week),another group was treated with RAPA(0.5mg/times,twice a week),no other drugs and immunosuppressants(except hormones and hydroxychloroquine)should be used in either group.Detect the changes of the count of Th17 cells and Treg cells in peripheral blood of patients with SLE before and after the treatment of ATRA+RAPA and RAPA respectively.Observe the changes of SLEDAI scores,ESR and hormone usage before and after the treatment of ATRA+RAPA and RAPA respectively.And analyze the differences in efficacy between the two groups.Using SPSS 20.0 Software for data analysis.The measurement data in accordance with normal distribution were expressed byx±S,and those that did not fit normal distribution were expressed by M±(QR).The analysis of variance of repeated measurements was used in the comparison between groups,and the correlation analysis was performed by Pearson test.Results:1.The count of B cells,CD4~+T cells and NK cells in the SLE group were lower than that in healthy control group(P<0.05).The count of CD8~+T cells were higher than that of the healthy control group(P=0.002).The count of Th1 cells,Th2 cells,Th17 cells and the ratio of Th1/Th2 cells,the ratio of Th17/Treg cells in the SLE group were higher than that in healthy control group(P<0.05).The count of Treg cells were lower than that of the healthy control group(P=0.002).2.There was a positive correlation between the count of Th17 cells and the SLEDAI scores in patients with SLE(r=0.293,P=0.039).There was no correlation between the count of Th17 cells and disease duration,ESR.There was no correlation between the count of Treg cells and disease duration,SLEDAI scores,ESR.3.After ATRA+RAPA treatment,the count of Th17 cells in SLE patients decreased,but it was not statistically significant(P=0.141).The count of Treg cells did not change significantly(P=0.605).The ratio of Th17/Treg cells decreased but there was no statistical significance(P=0.086).SLEDAI scores were significantly decreased(P=0.001).ESR did not change significantly(P=0.102).Hormone usage was significantly decreased(P=0.042).4.After RAPA treatment,the count of Th17 cells in SLE patients decreased,but it was not statistically significant(P=0.141).The count of Treg cells was decreased,but there was no statistical significance(P=0.605).The ratio of Th17/Treg cells decreased but there wasnostatisticalsignificance(P=0.086).SLEDAIscoresweresignificantly decreased(P=0.001).ESR did not change significantly(P=0.102).Hormone usage was significantly decreased(P=0.042).5.Compared with RAPA group,the ATRA+RAPA group had a significantly lower count of Th17 cells(P=0.024),and there was no significant difference between the two groups in the change of the count of Treg cells,the ratio of Th17/Treg cells,SLEDAI scored,ESR and hormone usage(P>0.05).Conclusion:1.There is an imbalance of Th17/Treg cells in SLE patients,which is manifested by an increase in the count of Th17 cells and a decrease in the count of Treg cells.2.Both ATRA+RAPA and RAPA can decrease the SLEDAI scores and improve the clinical symptoms of SLE patients.3.Both ATRA+RAPA and RAPA can reduce the dose of glucocorticoids and reduce the risk of side effects such as infection,osteoporosis,and diabetes.4.Compared with RAPA alone,combination of ATRA and RAPA can reduce the level of Th17 cells in peripheral blood of SLE patients in a short period of time. |
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