Study On The Correlation Between Cold-heat Syndrome Of Rheumatoid Arthritis And Intestinal Flora

Objective The differences of intestinal flora composition and diversity characteristics between rheumatoid arthritis patients with blockage type and dampness-heat blockage type and healthy people were compared,and the disease information of patients was analyzed.Then,to explore the characteristics of disease information and the characteristics of intestinal flora in two types of RA patients with Traditional Chinese Medicine(TCM)syndromes.Methods A survey was conducted on RA patients who were hospitalized in the Department of Rheumatology and Immunology,Hospital of Traditional Chinese Medicine in Inner Mongolia Autonomous Region from January 2020 to November 2020.Patients were screened according to the inclusion criteria and exclusion criteria.The resident physician records the patient’s general information and related laboratory examination results,and calculates the disease index and the total score of TCM syndromes,and then the physician with the title of deputy chief physician determines the patient’s syndrome type(cold-dampness blockage type and dampness-heat blockage type).6 newly diagnosed RA patients were selected from both cold and hot groups and divided into group A and group B,totally 12 patients,and collected their feces.Then 10 healthy human feces were collected as the control group(group C).Perform 16 S r DNA high-throughput sequencing on all feces.Use statistical software for data analysis,compare and summarize the differences between the cold and hot groups.Results(1)There was no statistical significance in gender,age,course of disease,distribution of morning stiffness time and number of joint tenderness and swelling between RA patients with cold and heat syndromes(P>0.05).(2)The erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)of the dampness-heat blockage type were higher than those of the cold-dampness blockage type,and the difference was statistically significant(P<0.05).(3)Rheumatoid factor(RF),anti-cyclic citrullinate peptide antibody(anti-CCP),anti-mutant citrullinate vimentin antibody(anti-MCV)were correlated with RA.The comparison between the two types showed that the dampness-heat blockage type was higher than cold-dampness blockage type,and the difference was statistically significant(P<0.05).(4)Some of the disease activity indexes in the dampness-heat blockage type was higher than that in the cold-dampness blockage type,and the difference was statistically significant(P<0.05).The total score of TCM syndrome in cold-dampness blockage type was higher than that in dampness-heat blockage type,and the difference was statistically significant(P<0.05).(5)Alpha diversity analysis showed that intestinal flora richness of group B was lower than that of the control group,and no significant change in group A.NMDS analysis in Beta diversity analysis showed that there were some differences in the structure of the three groups of bacteria.(6)At the level of phylum classification,the abundance of Acidobacteriota in group B decreased compared with group C(P<0.05),the abundance of Myxococcota in group B increased compared with group C(P<0.05),and the Desulfobacterota and Gemmatimonadetes in group A showed a decreasing trend compared with group B and C(P<0.05).At the level of genus classification,Agathobacter and Ruminococcus in group A were significantly higher than those in group B and C(P<0.05),Lachnoclostridium in group A showed A decreasing trend compared with that in group C(P<0.05),and Prevotella in group A was significantly higher than that in group C(P<0.05).At the level of species classification,Ruminococcus＿sp＿N15.MGS-57 species,Blautia＿Obeum species,Alistipes＿inops species and Lactococcus＿lactis in group A were significantly higher than those in group B and C(P<0.05),and Preprevella＿copri species in groups A and B were significantly higher than those in group C(P<0.05).Conclusion(1)There are differences in anti-CCP,anti-MCV,Ig M-RF,ESR,CRP,and multiple disease evaluation indexes in patients with different cold and heat syndromes of RA,which can provide an objective reference for the differentiation of cold and heat in TCM.(2)Compared with healthy people,the richness of intestinal flora in RA patients with dampness-heat blockage syndrome decreased,but there was no significant change in RA patients with cold-dampness blockage syndrome.There were differences in the bacterial community structure between RA patients with cold-dampness and dampness-heat obstruction syndrome.(3)The abundance of Agathobacter,Ruminococcus＿sp＿N15.MGS-57,Prevella Copri,Lachnospiraceae＿bacterium＿GAM79 and Lactococcus＿lactis in the intestinal flora of RA patients with cold-dampness blockage syndrome increased significantly,while the abundance of Gemmatimonadetes significantly decreased.(4)The abundance of Myxococcota and P.Copri in the intestinal flora of RA patients with dampness-heat blockage syndrome increased significantly,while the abundance of Acidobacteriota decreased significantly.