Correlation Study Between Tfh Cells And Their Balance With B Cell Subsets And The Development Of SLE

ObjectiveTo explore the role of Tfh cells and their balance with B cell subsets in the genesis and development of SLE,so as to provide a new theoretical basis for the diagnosis and treatment of SLE.MethodsCase control study was used in this study.From September 2018 to November2019,35 SLE patients which treated in the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of China University of science and technology and 40 healthy controls in the health examination center of the First Affiliated Hospital of Anhui Medical University were selected,peripheral venous blood and their clinical and general data were collected.Flow cytometry was applied in detecting the proportions and number of Tfh cells and B cell subsets in peripheral blood of SLE patients and healthy controls.The correlation between cell subsets,the relationship between Tfh cells,Tfh cells and B cell subsets balance and the clinical data of SLE patients were analyzed,and the value of Tfh cells in the clinical application of SLE was explored.T-test,Mann-Whitney U rank sum test,Pearson correlation,Spearman correlation,ROC curve was applied in the study.ResultsThe average age of SLE patients and healthy controls were?32.26±9.82?years and?34.05±9.22?years,respectively,with no significant difference?P=0.418?.The percentages of Tfh cells?CD4⁺CXCR5⁺T?in peripheral blood of SLE patients were17.87%±10.51%,higher than that of Tfh cells in healthy controls?8.18%±6.06%??P<0.001?;the percentages of Breg cells(CD19⁺CD24^hiCD38^hiB)were 5.42?1.31,8.69?%,higher than that of Breg cells in healthy controls 2.19?1.31,3.53?%?P=0.019?;the percentages of Bmem cells(CD19⁺CD24^hiCD38^lowB)?43.34%±13.33%?were higher than that of the healthy control?37.13%±12.75%??P=0.043?.There was no difference in the number of cells between SLE patients and healthy controls?P>0.05?.However,the number of Tfh cells in the peripheral blood of patients with active SLE was higher than that of patients with inactive SLE?P=0.009?.The number of Tfh cells was positively correlated with the number of Bmem cells in the peripheral blood of SLE patients,and the number of Tfh cells was positively correlated with the number of Breg cells in the peripheral blood of inactive SLE patients,but there was no correlation between the proportions of Tfh cells and B cell subsets in the peripheral blood of SLE patients.The number of Tfh cells in peripheral blood of SLE patients was negatively correlated with the level of complement C3,positively correlated with SLEDAI,but not correlated with ESR and CRP;the proportions of Tfh cells were negatively correlated with the levels of complement C3 and ESR,positively correlated with SLEDAI;Tfh/Breg and Tfh/Bmem were negatively correlated with complement C3,and Tfh/Bmem was positively correlated with SLEDAI.The number of Tfh cells in the peripheral blood of patients with SLE was not related to the qualitative index and clinical manifestation of SLE?P>0.05?,but the proportions of Tfh cells in patients with low complement SLE were higher than that in patients with non-low complement SLE?P=0.017?,and the proportions and number of Tfh cells were not related to the clinical medication?P>0.05?.Tfh/Breg in SLE patients with skin rash was higher than that in patients with non-skin rash?P=0.049?,Tfh/Bmem in patients with low complement SLE was higher than that in patients with non-low complement SLE?P=0.020?,Tfh/Breg in peripheral blood in patients with glucocorticoid?7.5 mg/d was lower than that in patients with glucocorticoid>7.5 mg/d?P=0.005?.ROC curve analysis showed that the sensitivity of the proportions of Tfh cells in identifying SLE was 0.69?95%CI:0.51-0.83?,the specificity was 0.78?95%CI:0.62-0.89?,and AUC was 0.801?95%CI:0.692-0.884?.The sensitivity,specificity and AUC of the proportions of Tfh cells in distinguishing active SLE from inactive SLE were 0.95?95%CI:0.75-1.00?,0.67?95%CI:0.38-0.88?and 0.853?95%CI:0.693-0.950?respectively.ConclusionThe proportions of Tfh cells and their interacting B cell subsets in peripheral blood of SLE patients increased,and the abnormality of Tfh cells and the imbalance between Tfh cells and B cell subsets may be responsible for the pathogenesis and development of SLE;the detection of the proportions of Tfh cells in peripheral blood play a good role in the differential diagnosis and disease assessment of SLE patients.