| Objective:1.To explore the effect of mid-term low-dose all-trans retinoic acid(ATRA)on the efficacy of patients with rheumatoid arthritis(RA);2.Dynamic observation of changes in peripheral blood lymphocyte CD4~+T cells in RA patients receiving low-dose all-trans retinoic acid.Methods:1.Case collection:34 patients who had been diagnosed with RA(not treated with all-trans retinoic acid before enrollment)were enrolled as a case group and received low-dose all-trans retinoic acid(ATRA)after enrollment.All patients with RA met the2010 ACR/EULAR classification criteria for rheumatoid arthritis and excluded those with severe infections,tumors,and other autoimmune diseases(AIDs),as well as pregnant and lactating women.Twenty healthy adults with age and gender matching were selected as healthy controls.Peripheral blood CD4~+T lymphocyte subsets and immune function values were provided by the Department of Rheumatology and Immunology,Second Hospital of Shanxi Medical University.Flow cytometry was used for cell counting and magnetic bead sorting.2.The clinical data of 34 patients with RA who underwent all-trans retinoic acid(ATRA)treatment at 0,3,6 and 1 year were followed up and followed up,which were set as case group and 3 month after treatment.The 6-month group after treatment and the 1-year group after treatment.20 healthy controls were selected.3.The blood routine,erythrocyte sedimentation rate and DAS28 scores of RA patients in the case group and the treatment group were analyzed.The changes and differences of each index in the case group and the treatment time group were analyzed,and the disease activity degree after treatment was evaluated.4.The peripheral blood CD4~+T lymphocyte subsets of the RA group and 20 healthy controls in the case group and the treatment group were compared,and the peripherals of the RA group and the healthy control group in the case group and the treatment period were compared.Changes and differences in blood CD4~+T lymphocyte subsets.Statistical methodStatistical analysis of the data was performed using SPSS 22.0 software.The measurement data is normalized,and the measurement data conforming to the normal distribution is statistically described by the method of mean±standard deviation.For the measurement data that does not obey the normal distribution,the median(lower quartile-upper quadrant)is used.The method of digits is described.For the measurement data that conforms to the normal distribution,the paired T test is used;for the measurement data that does not conform to the normal distribution,the comparison between the two groups is performed by the rank sum test,and the comparison between the groups is performed by the Kruskal-Wallis test.Further two-two comparisons are made.The count data was analyzed by chi-square test.The inspection level set by the above test is P=0.05.Result1.During the follow-up period,26 cases were collected in the 3 months after the data were collected to meet the data integrity,14 cases in the 6 months after treatment,and 16cases in the 1 year after treatment.2.Compared with healthy controls,peripheral blood CD4~+CD25~+FOXP3~+Treg cells in patients with RA the absolute counts(hereinafter referred to as Treg cells)were significantly lower[22.22(13.95,28.14)vs.34.15(23.17,45.59),P=0.002],and the percentage of Treg cells(Treg%)was also significantly decreased[3.64(2.42,4.77)vs.5.29(4.18,6.49),P=0.005],Th17/Treg cell ratio increased[0.30(0.19,0.43)vs.0.20(0.16,0.32),P=0.038],both statistically significant.There were no significant differences in absolute counts and percentages of Th17 cells,absolute counts and percentages of Th1cells,and absolute Th2 counts and percentages(P>0.05).3.After treatment,the ESR of the group was significantly lower than that of the case group.There were significant differences among the groups,P<0.001,and there was a significant downward trend with the prolongation of treatment time.4.After treatment,the DAS28 scores in the time group were significantly lower than those in the case group(P<0.001).As the treatment time prolonged,the overall DAS28showed a downward trend.5.There were significant differences in the absolute value of Treg between the case group and the post-treatment group(?2=10.45,P=0.015).After treatment,the 3 month group,the 6 month group,and the 1 year group Treg Absolute value counts showed an overall upward trend with the time of treatment with retinoic acid,which was significantly higher than that of the case group,but still slightly lower than the healthy control group.Th2%and Th2 absolute value counts were statistically different among groups(Th2%:?2=10.66,P=0.014,Th2:?2=8.925,P=0.030),and Th1%,Th1 absolute value count,Th17 There was no significant difference in the absolute value of%,Treg%,Th17 and Th17/Treg(P>0.05).6.Compared with the healthy control group,the percentage of Treg%(?2=14.585,P=0.002)was compared between the groups at each time point after treatment,and the Treg%of each group was healthier after treatment.The control group was reduced.The absolute value of Treg in the 3 month group,the 6 month group and the 1 year group increased with the time of treatment with retinoic acid,which was significantly higher than that of the baseline group before treatment,but still slightly lower than that of the healthy control group.Conclusion:1,Medium-term low-dose all-trans retinoic acid treatment can effectively reduce the erythrocyte sedimentation rate,DAS28 score and other indicators of RA patients,to some extent reduce disease activity and relieve the disease.2.The level of CD4~+CD25~+FOXP3~+Treg cells in peripheral blood of patients with RA is lower than that of normal people.The medium-dose low-dose all-trans retinoic acid treatment can increase the level of CD4~+CD25~+FOXP3~+Treg cells in peripheral blood to a certain extent.Helps maintain Th17/Treg homeostasis and achieve a certain degree of disease remission. |
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