Study On Peripheral Blood Lymphocyte Subsets And Related Immune Index In Primary Sj?gren's Syndrome Patients With System Involvement

Objective:To determine the levels and differences of peripheral blood lymphocyte subsets including Th17 cells and CD4~+Treg cells in patients with primary Sj?gren's Syndrome(pSS)with or without systemic involvement.To comparison the level and differences of peripheral blood lymphocytes and their subpopulations(Th17 cells,CD4~+Treg cells),cytokines,immunoglobulins,and inflammatory markers in patients with pSS who had no system involvement,involvement of the blood system,involvement of the lungs,involvement of the liver,and involvement of both systems.Methods:From December 2017 to January 2019,77 pSS patients in our hospital were divided into unsystematic involvement group(n=17)and systematic involvement group(n=60),including blood system involvement group(n=24),lung involvement group(n=14),liver involvement group(n=10),kidney involvement group(n=4),two-system involvement group(n=7)and three-system involvement group(n=1).Among them,the cases of kidney and three-system involvement can not be statistically analyzed,so eliminated.At the same time,the clinical data of 72 patients with pSS included in the study were collected:sex,age and other general basic data;erythrocyte sedimentation rate(ESR),C reactive protein(CRP),serum globulin(GLO),immunoglobulin G(IgG),immunoglobulin M(IgM),cytokines,lymphocytes,CD4~+T cell subsets(Th17 cells,CD4~+Treg cells)and other indicators.30 healthy people in our physical examination center were selected for lymphocyte subsets.The above laboratory indexes were obtained from the Laboratory and Laboratory of Rheumatology,the second Clinical Medical College of Shanxi Medical University,in which the absolute number of lymphocytes was detected by flow cytometry.All the Treg cells in this study were CD4~+CD25~+FOXP3~+labeled cells.Statistical method:Data processing was performed using software SPSS20.0,and the categorical variables were expressed using frequency.Continuous variable obey normal distribution using independent sample t test Continuous variables were non-normally distributed,using median quartile spacing,and the measurement data between groups did not follow a normal distribution,using the independent sample Kruskal-Wallis test.P?0.05 indicates that a significant difference exists.Results:Compared with healthy controls,patients with systemic involvement in pSS had lower levels of T cells in peripheral blood(P=0.012),and there was no significant difference in peripheral blood Th17 cells between patients without systemic involvement and healthy subjects(P=0.964),whereas Treg cell levels were reduced(P=0.05).Patients with systemic involvement had significantly lower levels of Th17 cells and Treg cells than healthy controls(P<0.001,P=0.006).The level of Th17 cells in patients with lung involvement was significantly lower than that in patients without systemic involvement and liver involvement(P=0.003).The level of IL-6 in peripheral blood of patients with hematologic involvement was lower than that in patients without systemic involvement(P=0.029).The immunoglobulin M in patients with liver involvement was higher than that in the system-independent group,the lung involvement group,and the blood system(P=0.006).Conclusion:Defects in immune tolerance caused by decreased Treg cells may be involved in the pathogenesis of pSS.The level of Th17 cells in peripheral blood of patients without system involvement was not statistically different from that of healthy controls.But the level of Th17 cells in patients with systemic involvement was significantly lower than the control group.The system involvement group was significantly reduced compared with the other groups,suggesting that system involvement of the pSS may not be related to Th17 cell-mediated inflammatory response,but may be associated with a reduction in immune tolerance defects due to a decrease in Treg cells,with the lungs involvement being particularly prominent.Patients with liver involvement had significantly higher peripheral blood immunoglobulin M than other groups,and IL-6 levels in patients with hematologic involvement were significantly lower than those without systemic involvement,further suggesting that IgM increased in pSS patients with liver involvement.IL-6 reduction may be involved in the involvement of the pSS blood system.