The Role Of Tumor Necrosis Factor Antagonis In Th17 And Treg Cells And Cytokines Of Patients With RA/AS

Objective:To investigate the changes of Th17/Treg cell ratio and related cytokines in patients with RA and AS before and after treatment with TNF-α antagonists and their effects on disease activity.Methods:From July 2018 to February 2019,27 patients with RA(DAS28 score ≥ 5.1,that is high active stage)and 27 patients with AS(BASDAI score≥4.0,active stage)were treated with TNF-α antagonist(54 patients were treated with non-steroidal anti-inflammatory drugs and recombinant human tumor necrosis factor receptor antibody fusion protein for injection only for 24 weeks.50 mg was injected subcutaneously once a week).The changes of Th17/Treg cell ratio and related cytokines at baseline,12 weeks and 24 weeks after treatment were recorded by flow cytometry and Cytometric Bead Array(CBA),and the correlation of Th17/Treg cell ratio and related cytokines with disease activity was analyzed.Results:DAS28 score and BASDAI score were positively correlated with Th17 cells,TNF-α,IL-6 and IL-17,while BASDAI scores and DAS28 scores were negatively correlatedwith Treg cells.With the extension of treatment time,the ratio of Th17/Treg in the RA group decreased significantly,With the extension of treatment time,the ratio of Th17/Treg in the AS group also decreased significantly.After 24 weeks of treatment,the Th17 cells and Th17/Treg ratio in the effective group were significantly lower than those in the ineffective group(P<0.05),Treg cells in the effective group were significantly higher than those in the ineffective group(P<0.05)in both groups.With the extension of treatment time,the levels of IL-6,IL-17 and TNF-α decreased significantly in the two groups.After 24 weeks of treatment,TNF-α in the effective group was significantly lower than that in the ineffective group,while there was no significant difference in IL-4,IL-6,IL-10 and IL-17 between the effective group and the ineffective group in RA,while the TNF-α and IL-17 in the effective group were significantly lower than those in the ineffective group,while the levels of IL-4,IL-6 and IL-10 were not significantly different between the effective group and the ineffective group in AS.Conclusion:1.TNF-α antagonist can reduce Th17/Treg ratio and TNF-α,thus controlling disease activity.2.TNF-α antagonists also acted indirectly on the immune function through IL-6,IL-17.