The Correlation Between Idiopathic Inflammatory Myopathy Specific Antibodies And TCM Syndromes

Objective:Idiopathic inflammatory myopathy is a group of autoimmune diseases characterized by limb proximal myasthenia,mainly involving skeletal rhabdomyosis.The clinical manifestations of this disease are of certain heterogeneity,including skin rash,heliotrope rash,Gottron sign,palm epidermal hyperplasia,skin ulcer,accompanied by myalgia,joint pain and other symptoms.With the improvement of the detection rate of myositis specific antibody(MSAs),different patients with positive MSAs antibody were found to have different clinical manifestations and prognosis.However,there are still deficiencies in the treatment based on syndrome differentiation of MSAs in TCM,In this study,clinical symptoms,TCM syndromes and clinical indicators of IIM patients with different MSAs grouping were observed to provide new ideas and methods for TCM syndrome differentiation of IIM patients,And to verify the new classification standards issued in 2017 by Chinese academy of traditional Chinese medicine.Methods:The information of 102 patients in the department of rheumatology and immunology in China-Japan friendship hospital was collected,including the age,gender,main clinical symptoms,complications and other general information were recorded.TCM syndrome is to identified by Senior doctor,we also collect ESR,CRP,LDH,CK,IgA,IgG,C3,CD3+,and other clinical indicators.MSAs was determined by western blotting or ELISA.Use Excel to build database.Use SPSS20.0 statistical software was used to process the data.The measurement data conforming to the normal distribution were expressed as mean standard deviation,the comparison of counting data was expressed as percentage(%),and the chi-square test was used for analysis.Univariate anova and multivariate disordered logistic regression were used for comparison among multiple groups,and P<0.05 was considered statistically significant.Results:A total of 100 patients were included in the statistical analysis,including 32 patients with damp-heat stasis syndrome,40 patients with Yin deficiency and heat stagnation syndrome,and 35 patients with spleen deficiency and phlegm-dampness syndrome.MSAs total positive rate of 79%,the anti-MDA5 antibody,anti-ARS antibody,anti-TIF1-γ antibody are the most common three subtypes,respectively 24%,20%,15%of the total,followed by 13 patients with anti-NXP2 antibody,7 patients with Mi-2 antibody,and anti-SRP antibody positive patients 6 cases.The distribution of gender and age of onset among TCM syndromes was not significant,the age of onset was the lowest in the anti-NXP2 group(P=0.031<0.05);In patients with a course of more than 3 months,Yin deficiency and heat stagnation syndrome and spleen deficiency and phlegm-dampness syndrome were the main syndromes,while in patients with a course of 0.5～3 months,dampness and heat stasis syndrome were the main syndromes.The duration of the anti-SRP antibody group and the anti-nxp2 antibody group was longer than that of the anti-ARS antibody group;Damp-heat stasis syndrome was not significantly distributed among MSAs groups,Yin deficiency heat stagnation syndrome was mostly distributed in anti-MDA5 antibody group,anti-TIF1-｜ antibody group and anti-ARS antibody group,and spleen-deficiency phlegm-dampness syndrome was significantly increased in anti-SRP group and anti-NXP2 antibody group(P<0.01).The levels of CRP and ESR in dampness-heat stasis syndrome and spleen-deficiency phlegm-dampness syndrome were higher than Yin deficiency heat stagnation syndrome.The levels of CK and LDH in spleen-deficiency phlegm-dampness syndrome were higher than those in dampness-heat stasis syndrome and Yin deficiency heat stagnation syndrome.The levels of IgG and IgA in the damp-heat stasis syndrome were lower than those in the spleen-deficiency phlegm-dampness syndrome,and the levels of complement C3 in the Yin deficiency heat-stagnation syndrome were lower than those in the spleen-deficiency phlegm-dampness syndrome and damp-heat stasis syndrome.CD8+ level of damp-heat stasis syndrome was significantly lower than that of the other two groups.In the case of IIM with yin-deficiency heat stagnation and damp-heat stasis syndrome,the incidence of pull-deficiency phlegm-dampness syndrome was higher than that of the other two groups,while the incidence of yin-deficiency heat stagnation syndrome with tumor was higher than that of the other two groups.Conclusion:The main syndrome type of IIM is Yin deficiency heat stagnation syndrome(41%),followed by spleen deficiency phlegm-dampness syndrome(31%)and dampness-heat stasis syndrome(28%).It was found that the Yin deficiency heat depression syndrome is associated with the elevation of LDH,the combination of tumor,positive anti-tifl-yantibody and positive anti-ARS antibody.Damp-heat stasis was associated with increased CRP,decreased CD8+cells,heliotrope rash and anti-MDA5 antibody.Spleen-deficiency phlegm-dampness syndrome was associated with significantly increased CK,dysphagia,anti-NXP2 and muscle swelling.