Clinical And Basic Research On Different Syndrome Differentiation Of Rheumatoid Arthritis Based On Inflammatory Cytokine Expression Profile

Objective: Rheumatoid arthritis(RA)is a chronic autoimmune disease characterized by systemic polyarticular synovial inflammation,pannus formation,and bone destruction.Its pathogenesis involves the participation of multiple cytokines.According to the clinical characteristics of RA,it belongs to the category of“Arthralgia” in Chinese medicine.It is often divided into the syndrome of wind-cold-dampness arthralgia,rheumatism-heat arthralgia syndrome,cold-heat complex syndrome,phlegm-stasis arthralgia syndrome,liver and kidney deficiency syndrome,and blood deficiency-cold coagulation syndrome.Studies have shown that there is a certain correlation between the different types of RA and inflammatory cytokines.In order to further systematically explore the relationship between RA syndrome differentiation and related cytokines,this study used Bio-plex suspension chip technology to detect the levels of cytokines in the peripheral blood of patients with RA syndromes and healthy people.It is verified on the rat model of syndrome,which will provide a basis for clarifying the biological basis of TCM syndrome in the future.Methods:(1)According to the diagnostic criteria of Western medicine for RA and the diagnostic criteria of TCM syndromes,10 eligible patients with wind-cold-dampness syndrome,rheumatic-heat syndrome,cold-heat syndrome,liver and kidney deficiency syndrome,and blood deficiency-cold coagulation syndrome were selected from 120 samples.Collect blood samples from 10 healthy people as controls.Test the blood routine,liver function and immunological indexes of RA patients and normal people in each group.The Bio-plex suspension chip technology was used to detect 15 inflammatory factors related to the pathogenesis of RA.(2)Establish a rat model of adjuvant-induced arthritis(AIA),and on this basis,apply wind-cold-dampness(FHS)stimulation to establish a rat model of AIA wind-cold-dampness arthralgia syndrome,and use Bio-plex suspension chip technology to detect the possible correlation with its pathogenesis Of 23 inflammatory factors.Results: The onset of RA was accompanied by many inflammatory reactions.In clinical studies,it was found that compared with the normal group,the expression of RF,ESR and CRP of RA syndrome groups were significantly increased,and the expression of RBC and HGB was significantly reduced.The expression of inflammatory factors such as IL-1?,IL-6,IL-10,IL-17 A,IL-17 F,IL-21,IL-22,IFN-?,s CD40 L and TNF-? in the wind-cold-dampness arthralgia syndrome group were significant increased,IL-23 was significantly reduced.The expression of IL-6,IL-21,IL-22 and TNF-? in the rheumatic arthralgia syndrome group were significantly increased,and IL-23,IL-31 were significantly decreased.The expression of IL-1?,IL-6,IL-17 F,IL-21,IL-22,IL-33 and TNF-? in the cold-heat complex syndrome group were significantly increased,and IL-23,IL-31 were significantly decreased.The expression of IL-1?,IL-10,IL-17 F,IFN-? and TNF-? in the liver and kidney deficiency syndrome group were significantly increased,and IL-23,IL-31 were significantly reduced.The expression of IL-6,IL-17 F,IL-21,IL-33,IFN-? and TNF-?in the blood deficiency and cold coagulation group were significantly increased,and IL-23,IL-31 and s CD40 L were significantly decreased.Comparing with other syndrome types,The expression of ESR,IL-6,IL-17 A,TNF-?,s CD40 L in the wind-cold-damp arthralgia group were significantly higher,and the expression of IL-21 in the rheumatic-heat syndrome group was significantly higher.The expression of RF,IL-25 in the cold-heat complex syndrome group were significantly increased,and the liver and kidney deficiency syndrome group had no significant change.The expression of IL-21,IL-33 in the blood deficiency and cold coagulation syndrome group were significantly increased,and s CD40 L was significantly decreased.In the rat model of AIA wind-cold-damp arthralgia syndrome,it was found that the levels of inflammatory factors in the AIA group and the AIA+FHS group were significantly higher than those in the normal group.Compared with AIA rats,the serum levels of IL-5,IL-17 A and RANTES in the AIA+FHS group increased,while the VEGF content decreased.Conclusion: Comprehensive clinical research and animal experiments,this study found that there is a certain correlation between the different TCM syndrome types of RA and inflammatory factors,but because of the limited samples of this experiment and the current RA disease model only replicates the AIA wind-cold-dampness syndrome,and the other methods of disease model are still being explored,so it is not enough to use the experimental results as the basis for RA TCM syndrome differentiation.It is still necessary to further clarify the biological basis of RA TCM syndrome types through experimental research and large samples of clinical data.