Clinical Characteristics Of Traditional Chinese Medicine For Primary Sj(?)gren's Syndrome And Its Correlation With MiRNA-146a

Objective: 1)To analyze the clinical data of hospitalized patients with Sj?gren's syndrome and discuss the clinical features.2)To explore Chinese medicine constitution and syndrome type characteristics of primary sj?gren's syndrome patients.3)In order to assess the relationship of miRNA-146 a expression and pSS susceptibility,the meta-analysis was performed.To verify the difference of miRNA-146 a expression between pSS and normal control group,to explore the correlation between the expression of miRNA-146 a in peripheral blood of pSS patients and qi and yin deficiency syndrome,and to analyze its clinical characteristics.Methods: 1)The hospitalized medical records of patients with Sjogren's syndrome who were admitted to the medical records archive for five years were retrospectively analyzed and their clinical characteristics and laboratory indicators were analyzed.2)General information of 60 pSS patients was collected.Chinese medicine syndrome and Chinese medicine constitution types were decided,and the distribution of pSS patients was analyzed.3)The Pubmed database,Cochrane Central Register of Controlled Trials,WANFANG Database,Chinese National Knowledge Infrastructure,and WEIPU Database were searched for relevant studies,which studied on the relationship between miRNA-146 a and primary Sj?gren's syndrome.The search deadline is October 2017.Meta-analysis was performed using RevMan 5.2.0 analysis software provided by the International Evidence-Based Medicine Collaboration Network.At the same time,in a prospective medical record control study,patients with pSS were divided into two traditional Chinese medicine(TCM)syndromes according to the TCM syndrome classification standard,and were classified according to classification criteria of TCM constitution.The miRNA-146 a expression were examined by RT-qPCR analysis in PBMCs from 60 patients with pSS and 30 healthy controls.Results: 1)Retrospective analysis showed:(1)female patients with Sj?gren's syndrome were much than men,accounting for 97.18%;male to female ratio was 1: 34.5;Han ethnic was most,accounting for 79.58%;Over 45-year-old patients was most,accounting for 80.28%.(2)Qi-Yin deficiency was most,accounting for 81.69%,wet-heat immersion syndrome was 9.86%,temper weak syndrome was 8.45%.(3)There was no difference in age,sex,residence time in Xinjiang,disease onset(initial,recurrence)among temper weak syndrome,wet-heat immersion syndrome and Qi-Yin deficiency Syndrome;There was no difference in dry mouth,dry eyes,skin manifestations,joint pain,low potassium and pulmonary interstitial fibrosis.(4)In addition to ESR,there was no statistical significance in the CRP,RF,IgA,IgG,IgM,C3,C4,and antibody repertoire positive proportions among the temper weak syndrome,wet-heat immersion syndrome and Qi-Yin deficiency Syndrome.There was no statistical difference between wet-heat immersion syndrome and Qi-Yin deficiency syndrome in ESR,and there was a statistical difference between temper weak syndrome and Qi-Yin deficiency syndrome in ESR.2)Among 60 pSS patients,58 cases(96.67%)were women,mean age was 52 years,an average duration was 63 months,residented in Xinjiang.The proportion of newly diagnosed patients was 23.33%,and the proportion of relapsed patients was 76.67%.Among them,only 43.33% of the patients with recurrence received medical education guidance on pSS.The most common first clinical symptoms were dry mouth,dry eyes,joint pain,skin and mucous membranes and blood system damage was rare.In pSS patients Qi and Yin deficiency syndrome was most(48.33%),followed by wet-heat immersion syndrome(26.67%),temper weak syndrome(25.00%).The top two types of constitution in pSS patients were Yin deficiency and Yang deficiency constitution(58.33%),followed respectively Qi deficiency(56.67%)>Qi stagnation(48.33%)>blood stasis constitution(38.33%)>phlegm-dampness constitution(36.67%)>damp-heat constitution(18.33%)>allergic constitution(13.33%)>yin-yang harmony constitution(1.67%).3)(1)Meta-analysis included 3 studies,including 76 patients with primary Sj?gren's syndrome and 62 controls.The meta-analysis shows that miRNA-146 a expression is associated with the risk of pSS significantly(MD=6.32,95%CI(1.91,10.73),P=0.005).(2)In prospective medical record control study,compared with the healthy control group,the primary Sj?gren's syndrome group had statistically significant differences in constitution of yin-yang harmony,constitution of qi asthenia,constitution of yin asthenia,constitution of phlegm-dampness,constitution of blood stasis and constitution of qi stagnation(P<0.05).There was no significant difference in constitution of yang asthenia,constitution of damp-heat,allergic constitution(P>0.05).The relative expression of miRNA-146 a was significantly higher in PBMC samples from patients with pSS than in the healthy controls(P<0.001).There was no statistical difference in miRNA-146 a,immunoglobulin(IgA,IgG,IgM),complement(C3,C4),white blood cells(WBC),red blood cells(RBC),platelet(PLT)count,hemoglobin(Hb),erythrocyte sedimentation rate(ESR),rheumatoid factor,CCP,anti-ANA antibody titer,anti-SSA antibody,anti-SSB antibody,R052 of patients with primary Sj?gren's syndrome between non-qi and yin deficiency group and qi and yin deficiency group(P>0.05).The unconditioned Logistic regression analysis showed that multiple factors,age(OR=1.07,P=0.04),miRNA-146a(OR=12198.70,P=0.01),and constitution of yin asthenia(OR=5.18,P=0.03)are the primary influence factors of pSS patients,and which are all risk factors.Compared with the non-qi and yin deficiency group,the patients with qi and yin deficiency syndrome had more thyroid dysfunction than those with non-qi and yin deficiency.There was statistical difference between them(P=0.01).Conclusion: 1)The TCM Features of the Sj?gren's syndrome has some significance for the clinical treatment.The CRP,RF,IgA,IgG,IgM,complement C3,C4,and the positive rates of antibody profiles(ANA,SSA,SSB,RO-52)in patients with primary Sj?gren's syndrome have no correlation with TCM syndrome.These indicators are not as a reference indicator for differentiation of TCM syndrome.2)TCM constitution of pSS patients had clinical features alone,Yin deficiency and Yang deficiency constitutions were most common.Qi-Yin deficiency syndrome type was most.Most recurrence patients had not received pSS health education.which showed that according to clinical syndromes type and characteristics of Chinese medicine constitution in pSS patients,we should give individualized treatment programs,while strengthening pSS health management and finally improving their life quality.3)The meta-analysis shows that miRNA-146 a expression is associated with the risk of pSS.In a prospective case-control study,the relative expression of miRNA-146 a was up-regulated in patients with primary Sj?gren's syndrome,further validating the results of the meta-analysis,suggesting that miRNA-146 a can be used as a biological indicator of primary Sj?gren's syndrome.There was no difference in the expression of miRNA-146 a between the Qi and Yin deficiency and non-Qi and Yin deficiency,which could not be used as the basis for TCM syndrome differentiation.Age,constitution of yin asthenia and miRNA-146 are the influencing factors of primary Sj?gren's syndrome and are all risk factors.Patients with Qi and Yin deficiency syndrome are more likely to have thyroid dysfunction than patients with non-Qi and Yin deficiency syndrome.