| ObjectiveTo determine whether Fcγ RⅡb variant and the the Kidney-deficiency Syndromes of TCM in rheumatoid arthritis increases the risk of bone destruction, and find the support evidence of immune mechanism of bone destruction in the Kidney-deficiency Syndromes of TCM in rheumatoid arthritis.MethodsThis study recruited 183 cases of rheumatoid arthritis patients from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Rheumatology department, and 237 cases of the health control. And the information of rheumatoid arthritis patients was collected, such as gender, age of onset, duration, number of swollen joints, and tender joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP antibody, DAS28-ESR, modified SHARP score and other clinical data. We collected Peripheral blood from patient group and control group, assessed their transmembrane segment Fcγ RⅡb 695T> C polymorphism. Then, Statistical analysis was applied to reveal the correlation between Fcγ RⅡb695T> C polymorphism and incidence, disease activity, bone destruction risk factors, and the Kidney-deficiency Syndromes of TCM, and it was used to confirm the findings.Results1. The distribution of genotypes and the frequencies of alleles among the RA patients and healthy controls were found to be similar (in pooled analysis, P=0.556,; OR 0.900; 95%CI 0.634-1.277 for TT versus TC+CC, and in Allele analysis P=0.410; OR 0.885; 95%CI 0.663-1.183)2. No statistically differences in the proportion of women, age of enrollment, duration, age of onset, DAS28-ESR, ESR, CRP, tender joint count, swollen joint count in the first visit were observed between the variant-type and wild-type individuals(P>0.05).3. Carriership of the FCGR2B variant was associated with significantly presence of rheumatoid factors(40.5% versus 15.0%;P=0.008; OR 4.235; 95%CI 1.353-13.255)compared with patients carrying the wild-type alleles. In contrast, the FCGR2B individual genotype was not associated with risk level of rheumatoid factor (P>0.05)4. The FCGR2B variant was not associated with presence and level of anti-cyclic citrullinated peptide antibody in the distribution of genotypes and the frequencies of alleles analysis among the patients who received the anti-cyclic citrullinated peptide antibody test.5. The FCGR2B individual genotype was not associated with the age of onset, and the FCGR2B variant was not associated with the onset after 49 year old.6. Ninety-one RA patients with the Kidney-deficiency Syndromes of TCM, and ninety-two RA patients without the Kidney-deficiency Syndromes of TCM were included in the present study. Of the former, there were the average onset age of 51.7 years. And of the latter, there were the average onset age of 48.2 years. A patients with the Kidney-deficiency Syndromes of TCM were associated with significantly higher levels of rheumatoid factor (mean±SD 796.758±1298.192 RU/ml versus 459.336± 770.682RU/ml) and higher age of enrollment (mean±SD 61.319±10.494 versus 48.250±12.867)and onset(mean±SD 51.758±12.413 versus 40.304±13.076), compared with patients without the Kidney-deficiency Syndromes of TCM.7. Carriership of the FCGR2B variant and the Fcγ RIIb695C Allele were associated with significantly the Kidney-deficiency Syndromes of TCM (respectively,54.9% versus 20.7%; P=0.000; OR 4.685; 95%CI 2.441-8.995, and 31.3% versus 10.3%; P=0.000; OR 3.960; 95%CI 2.242-6.994) compared with patients carrying the wild-type alleles, and the Fcγ RIIb695T Allele.8. RA patients with the Kidney-deficiency Syndromes of TCM were slightly higher at high risk level of rheumatoid factor (80.2% versus 67.4%; P=0.057) compared with RA patients without. However, this difference did not quite reach statistical significance. RA patients with the Kidney-deficiency Syndromes of TCM were not associated with high risk level of rheumatoid factor compared with absence of rheumatoid factor (P=0.240; OR 1.766; 95%CI 0.679-4.596). RA patients with the Kidney-deficiency Syndromes of TCM were similar in presence of rheumatoid factor (52.5%versus 47.8%; P=0.110) compared with RA patients without. RA patients with the Kidney-deficiency Syndromes of TCM were slightly higher at high risk level of anti-cyclic citrullinated peptide antibody (48.2% versus 38.6%; P=0.140) compared with RA patients without-yet again, these differences did not reach statistical significance. A patients with the Kidney-deficiency Syndromes of TCM were not associated with high risk level of anti-cyclic citrullinated peptide antibody compared with the absence (P=0.142; OR 2.563; 95%CI 0.708-9.274). RA patients with the Kidney-deficiency Syndromes of TCM were similar in presence of anti-cyclic citrullinated peptide antibody (91.2% versus 87.0%; P=0.215) compared with RA patients without.9. No differences in the modified SHARP score within different durations, high modified SHARP score within or beyond the first 5 years of onset, or the proportion of destructive RA were observed between the wild-type alleles and the variant-type alleles individuals, or between the patients with and without the Kidney-deficiency Syndromes of TCM.ConclusionThis study is shown that a single genetic variant, the FCGR2B 695T>C polymorphism is a critical determinant of the Kidney-deficiency Syndrom es of TCM; Higher rate of the FCGR2B variant individuals present rheumat oid factor, and higher level of rheumatoid factor within RA patients wit h the Kidney-deficiency Syndromes of TCM, suggest that the variant-type RA and patients with the Kidney-deficiency Syndromes of TCM are more act ive in auto-humeral immune, higher risk in bone destruction, and poorer prognosis.this study is shown no differences in bone destruction betwee n the wild-type alleles and the variant-type individuals, or between the patients with and without the Kidney-deficiency Syndromes of TCM. and t he reason might be that too much stratified and comparatively insufficie nt sample size. Our present study thus provides compelling evidence for the critical correlation of Fcγ RⅡb in the poor prognosis of RA and the Kidney-deficiency Syndromes of TCM. These findings warrant further in-d epth research to reveal the potential of targeting Fey RⅡb as a novel t herapeutic approach in RA with the Kidney-deficiency Syndromes of TCM. |
