| Objective: Patients with Rheumatoid arthritis of traditional Chinese medicine physique distribution and methotrexate drug metabolism related genes folinic acid MTHFR677 C > T gene polymorphism,to explore the correlation between traditional Chinese medicine constitution typing of RA patients and methotrexate MTHFR677C> T gene polymorphism.When there is no condition for genetic testing,the use of methotrexate should be guided according to the constitution of traditional Chinese medicine to provide new ideas for the treatment of RA by integrated traditional Chinese and Western medicine.Methods: A cross-sectional study was conducted to collect 203 RA patients who met the inclusion and exclusion criteria for MTHFR677 C > T gene locus detection in the outpatient department and ward of the rheumatology Department of the Hospital of Traditional Chinese Medicine of Inner Mongolia Autonomous Region from December 2021 to January 2023.The basic data of patients were collected by clinical investigation and questionnaire survey.According to the TCM Constitution Classification and Judgment Form filled in by patients,TCM constitution identification shall be carried out for patients;The genotypes of MTHFR677 C > T sites were determined by digital fluorescence molecular hybridization,and the Hardy-Weinberg balance law was used to test the genetic balance of patients with MTHFR677 C > T gene polymorphism.SPSS22.0 statistical software was used to analyze the correlation between RA constitution typing and methotrexate metabolism-related MTHFR677 C > T gene polymorphism.Results:1.From December 2021 to January 2023,a total of 203 patients with RA were included in this study,with an average age of 55.33±13.15 years old,including 49 males(24.14%)and154 females(75.86%).Among the 203 patients,10 were underweight,99 were normal,79 were overweight,and 15 were obese.Among the 203 patients,55 had hypertension and 148 had normal blood pressure.There were 25 patients with smoking history,including 21 males and 4 females.Alcohol history 15,all male.123 were CRP negative and 80 were CRP positive.There were 83 negative ESR patients and 120 positive ESR patients.Thirty-two RA patients with DAS28 scores had remission,29 had mild activity,87 had moderate activity,and 55 had high activity.2.In this study,the MTHFR677 C > T locus genotype was consistent with HardyWeinberg genetic balance(P > 0.05).3.MTHFR677 C > T gene polymorphism distribution: CC(wild homozygous type)42cases(20.69%),CT(mutant heterozygous type)106 cases(52.22%),TT(mutant homozygous type)55 cases(27.09%).The mutant allele frequency was 0.532.4.The distribution of TCM constitution in this study was as follows: 61 cases(30.0%)of Yang deficiency,43 cases(21.2%)of phlegm-dampness,33 cases(16.3%)of Yin deficiency,21 cases(10.3%)of dampness-heat,16 cases(7.9%)of qi deficiency,15 cases(7.4%)of qi stagnation,14 cases(6.9%)of blood stasis.5.Binary Logistic regression analysis: Compared with genotype CC,CT genotype was correlated with Yang deficiency(OR=3.281,95%CI:1.334-8.071,P=0.010),and TT genotype was negatively correlated with phlegm and dampness by 84%(OR=0.180,95%CI:0.059-0.549,P=0.03).TT genotype was correlated with Yin deficiency quality(OR=10.556,95%CI:2.297-48.505,P=0.002),and the difference was statistically significant(P<0.05).Conclusion:1.The proportion of TCM constitution types in RA patients from high to low were Yang deficiency,phlegm-dampness,Yin deficiency,damp-heat,qi deficiency,qi stagnation and blood stasis.2.The genotypes of methotrexate MTHFR677 C > T locus were CC type(wild homozygous type)20.7%,CT type(mutant heterozygous type)52.2%,TT type(mutant homozygous type)27.1%.3.There may be correlation between Yang deficiency,Yin deficiency,phlegm-dampness and methotrexate MTHFR677 C > T gene polymorphism in RA patients. |
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