类风湿关节炎合并肺间质疾病患者Treg/Th17免疫失衡与肠道菌群变化的关系

目的 探讨类风湿关节炎（RA）合并肺间质疾病（ILD）患者调节性T细胞（Treg细胞）/辅助性T细胞（Th17细胞）免疫失衡与肠道菌群变化的关系。方法 选取2021年6月-2022年6月于石家庄市人民医院收治的RA患者100例为研究对象，纳入RA组。根据临床症状、X射线及胸部HRCT检查评估结果，将RA组分为RA-ILD组39例和NO-ILD组61例。收集两组患者基线资料；检测Treg/Th17细胞及相关因子；对粪便DNA样本16S rRNA V3-V4区域进行生物信息学分析；使用Spearman相关性分析检验RA-ILD患者肠道菌群丰度与Treg/Th17相关性。结果 与NO-ILD组相比，RA-ILD组的Shannon指数、Observed_species指数及Chao1指数均明显较低，类杆菌属(Bacteroides)、嗜血杆菌属(Haemophilus)、梭状芽孢杆菌属(Acuformics-Prevot)、厚壁菌门(Firmicutes)、真杆菌属(Eubacterium)、乳杆菌属(Lactobacillus)、韦荣球菌属(Veilonella)相对丰度均明显较低，拟杆菌门(Bacteridetes)、变形菌门(Proteobactena)、戈登菌属(Ciordonaspp)、放线菌门(Actinobacteri)、普雷沃菌属(Prerotella)相对丰度均明显较高，Treg细胞比例及Treg/Th17明显较低，IL-23、IL-17水平及Th17细胞比例明显较高，差异均有统计学意义（〖WTBX〗P〖WTBZ〗<0.05）。Treg/Th17与类杆菌属、嗜血杆菌属、韦荣球菌属、真杆菌属、厚壁菌门、乳杆菌属的相对丰度呈明显正相关（均P<0.05），与普雷沃菌属、变形菌门、梭状芽胞杆菌属、放线菌门、戈登菌属、拟杆菌门呈明显负相关（均P<0.05）。结论 RA合并ILD患者存在Treg/Th17细胞比例失衡，而肠道菌群失衡可能是其失衡的主要原因

Study on the relationship between Treg/Th17 immune imbalance and intestinal microflora in patients with rheumatoid arthritis complicated with pulmonary interstitial disease

Objective To investigate the relationship between Treg/Th17 immune imbalance and intestinal microflora in patients with rheumatoid arthritis complicated with pulmonary interstitial disease (RA-ILD). Methods 100 patients with RA treated in our hospital from June 2021 to June 2022 were selected and included in the RA group. According to the clinical symptoms, X-ray and chest HRCT examination, the RA group was divided into RA-ILD group (n=39) and NO-ILD group (n=61). The clinical data and laboratory indexes of the two groups were collected. Treg/Th17 cells and related factors were detected. The fecal DNA was collected and extracted, and the 16s rRNA V3-V4 region of the samples was sequenced by Illumina Miseq sequencing platform, and the sequencing data were analyzed by bioinformatics. Spearman correlation analysis was used to test the correlation between intestinal flora abundance and Treg/Th17 in patients with RA-ILD. Results Compared with NO-ILD group, the Shannon index, Observed species index and Chao1 index of RA-ILD group were significantly lower, the relative abundance of Bacteriodetes, Haemophilus, Acuformic-Prevot, Firmicutes, Eubacterium, Lactobacillus and Veronella were significantly lower, and the relative abundances of Bacteroides, Proteus, Gordonella, actinomycetes, Prevos were significantly higher, and the proportion of Treg cells and Treg/Th17 were significantly lower. The levels of IL-23, IL-17 and the proportion of Th17 cells were significantly higher (P<0.05). Treg/Th17 was correlated with the relative abundance of Clostridium,Virococcus, Lactobacillus, Haemophilus, Haemophilus, Bacterium and Pleurota (P<0.05), and negatively correlated with Clostridium, Gordonella, Prevotella,Proteus, Actinomycetes and Bacteroides (P<0.05).Conclusion There is an imbalance in the proportion of Treg/Th17 cells in patients with RA complicated with ILD, and the imbalance of intestinal flora may be the main reason for the imbalance