Application Of Metformin In The Treatment Of Systemic Lupus Erythematosus By Regulating The Balance Of Th17/Treg Cell

Objective:1.To compare the expression of peripheral lymphocyte cells and its ratio to tregs in SLE patients with healthy controls(HC).2.To explore the expression of Th17 cells,Treg cells,NK cells,Ts cells and Th17/Treg cells,Ts/Treg cells,Th1/Treg cells,Th2/Treg cells in patients with SLE correlation with SLEDAI score,disease course,ESR.3.To analyse the changes of Th17 cells,Treg cells,Th17/Treg and ESR,SLEDAI score,drugs in SLE after treatment with metformin for 0,6,12 weeks.Methods:A total of 121 participants were involved in the study,including 61 SLE patients(93.33% of women,mean age 34.64±13.61)and 60 age,gender-matched healthy controls(HC)(90% of women,mean age 38.66±13.19).All participants did not have a history of diabetes.The 61 patients with SLE fulfilling the revised in 1997 by American College of Rheumatology(ACR)criteria who were admitted to the Second Hospital of Shanxi Medical Collage from January 2017 to January 2018.Peripheral blood lymphocytes were extracted from all subjects.Comparison of T,B lymphocyte cells,NK cells,Th cells,Th1 cells,Th2 cells,Th17 cells and Treg cells in SLE patients and healthy controls(HC).To analyse the relation of the abnormal index of SLE and the course of disease,ESR and SLEDAI score.According to SLE disease activity index(SLEDAI)2000 scale(Schedule 2),Among them,31 cases with SLEDAI score were less than 9,They were given metformin traditional drugs(including hormones,hydroxychloroquine).To collect their peripheralblood at 0,6 and 12 weeks and to extract Peripheral blood lymphocytes respectively.Comparison the changes of th17 cells,treg cells,Th17/Treg and ESR,SLEDAI score,drug dose in MET group.All the data were analyzed by SPSS 20.0.Results:1.Sex ratio and age difference in participants between SLE group and HC group,MET group and non-MET group had no statistical significance.2.NK cells(P=0.001),Treg cells(P <0.001)in the SLE group were significantly lower than those in the HC group,while Ts cells(P<0.001),Th17 cells(/ul)(P=0.006)were significantly higher;Th17/Treg ratio(P<0.001),Ts/Treg ratio(P<0.001),Th1/Treg ratio(P=0.004),Th2/Treg ratio(P=0.006)were significantly higher than those in the HC group.There is no statistical difference to the expression of T,B lymphocyte cells,Th cells,Th1 cells,Th2 cells,B/Treg cells,NK/Treg cells between SLE patients and healthy controls.3.Treg cells(/ul)were negatively correlated with SLEDAI score(r=-0.289,P=0.024).But it was not related to disease course and ESR.Th17 cells(/ul),Ts cells(/ul),NK cells(/ul)and Th17/Treg cells,Ts/Treg cells,Th1/Treg cells,Th2/Treg cells were no correlated with disease course,SLEDAI score,ESR.4.After 6 weeks of MET treatment,Treg cells in peripheral blood of SLE patients were significantly higher(P=0.054).Th17 cells(1/ul)were slightly elevated,and Th17/Treg ratio was decreased,but there was no statistical significance;12 weeks later,peripheral blood Treg cells(1/ul),Th17 cells,and Th17/Treg ratio were all lower than those at week 0,but they were not statistically significant.After 6 weeks of MET treatment,SLEDAI scores and ESR(mm/h)were all decreased,but there was no statistical difference.After 12 weeks of treatment,ESR(mm/h)decreased significantly(p=0.036),while SLEDAI score decreased still without statistical difference.After 6 weeks of Met treatment,the dosage of prednisone decreased significantly(p=0.019),but the dosage of hydroxychloroquine was not significantly changed.After 12 weeks of treatment,the dosage of prednisone was significantly lower than that of 0weeks(p=0.003),while the dosage of HCQ decreased,but there was no statistical significance.Conclusion:1.The SLE is related to the number of Treg cells,Th17 cells,NK cells,Ts cells,and the number of Treg cells is negatively correlated with the degree of disease activity.2.Met could increase the number of treg cells.3.MET can help to reduce hormones dose and reduce the disease activity of SLE patients.