Expression Of Peripheral Blood Th17/Treg Cells And Cytokines In Pathogenesis Of Childhood Myasthenia Gravis

Objective:To investigate the expression of peripheral blood T helper cell 17 (Thl7) and regulatory T cells (Treg) and related cytokines in pathogenesis of Childhood myasthenia gravis. After glucocorticoid treatment, Th17/Treg and related cytokines were detected again to investigate the immunoregulatory roles in the therapeutic effect and prognosis.Methods:From January 2013 to Ocotober 2013,36 children with myasthenia gravis(MG group) and 30 healthy control subjects (control group) were collected.Experimental group received glucocorticoid treatment. The expression of peripheral blood Th17/Treg cells were measured by flow cytometry (FCM) and the levels of interleukin-6 (IL-6), IL-10, IL-17, IL-21, IL-23, IL-35 and transforming growth factor-a (TNF-a),were evaluated by enzyme immunoassay (ELISA).Curative effect, comparative analysis and correlation study was assessed carried out before treatment and after treatment, respectively.Results:The percentages of Th17 cells in MG group were (1.422±0.78)%, which was significantly higher than those in control group((0.71±0.43)%, P< 0.05).The percentages of Treg cells in MG group were(1.590±0.12)%,which were significantly lower than those in control group(3.035±1.620)%(P< 0.001). The percentages of Th17/Treg cells in MG group were 0.89±0.50, which were significantly higher than those in control group(0.23±0.26, P< 0.05). The IL-6, IL-10, IL-17, IL-21, IL-23, TNF-a levels in MG group were also significantly higher than those in control group(all P< 0.05).The IL-35 levels in MG group was lower than those in control group(P> 0.05). There was a negative correlation between the percentages of Th17 cells and Treg cells (r=-0.444,P< 0.001). There was a negative correlation between the percentages of Th17 cells and TNF-a levels (r=-0.473,P<0.01).A positive correlation was shown between the percentages of Treg cells and TNF-a levels in MG (r=0.422,P<0.01). There was no correlation between IL-6, IL-10, IL-17, IL-21, IL-23, IL-35 levels and the percentages of Th17 cells/Treg cells/TNF-alevels (P>0.05). After glucocorticoid treatment, the absolute score of MG group was significantly increased (P<0.05) and the effective rate was 88.9%. The glucocorticoid treatment could significantly decrease the percentages of Th17 cells in MG group(t=2.836, P<0.01), but with no effect on the the percentages of Treg cells (t=0.935, P>0.05). The percentages of Th17/Treg cells, the IL-10, IL-21, IL-23 levels and the TNF-a levels were also decreased after glucocorticoid treatment (all P<0.05).Conclusion:There are imbalances of Th17/Treg cell in peripheral blood of children with myasthenia gravis.Th17/Treg cell and cytokines (IL-6, IL-10, IL-21, IL-23, and TNF-a) may play important role in Childhood myasthenia gravis and can be used as potential index of diagnosis and to evaluate the treatment effect of MG.