瘦素、CD4+-CD8+比值與類風濕關節炎中醫證型的關系分析摘要：目的：探討瘦素、CD4+/CD8+比值與類風濕關節炎中醫證型的關系。方法：選取2019年10月至2020年10月江蘇省人民醫院收治的118例類風濕關節炎患者為研究對象，以瘦素、CD4+/CD8+比值為指標，采用多元回歸分析，分析它們與類風濕關節炎中醫證型之間的相關性。結果：118例患者中，中醫證型以濕熱壅滯型最多，占34.75%。多元回歸分析顯示，瘦素與氣滯血瘀證型（β=0.703，P<0.05）、寒濕困痹證型（β=0.476，P<0.05）具有正相關性，與濕熱壅滯證型（β=-0.374，P<0.05）則具有負相關性；CD4+/CD8+比值與寒濕困痹證型（β=0.831，P<0.05）、氣滯血瘀證型（β=0.608，P<0.05）具有正相關性，與濕熱壅滯證型（β=-0.483，P<0.05）則具有負相關性。結論：瘦素、CD4+/CD8+比值與類風濕關節炎中醫證型有一定相關性，為中醫證型的診斷和治療提供一定參考價值。

關鍵詞：瘦素；CD4+/CD8+比值；類風濕關節炎；中醫證型；相關性分析

Introduction:Rheumatoidarthritis(RA)isachronicinflammatorydiseasecharacterizedbysymmetrical,peripheraljointinvolvement,typicallystartinginthesmalljointsofthehandsandfeet.ThepathogenesisofRAiscomplexandinvolvesmultiplegenetic,environmental,andimmunologicalfactors.TraditionalChinesemedicine(TCM)hasbeenusedtotreatRAforthousandsofyearswithgoodclinicaloutcomes.However,therelationshipbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRAhasnotbeenfullyelucidated.

Methods:Atotalof118patientswithRAadmittedtoJiangsuPeople'sHospitalfromOctober2019toOctober2020wereincludedinthisstudy.LeptinandCD4+/CD8+ratiowereusedasindicators,andmultipleregressionanalysiswasusedtoanalyzetheircorrelationwithTCMsyndromedifferentiationinRA.

Results:Amongthe118patients,theTCMsyndromedifferentiationwasmostlydamp-heatobstructionsyndrome,accountingfor34.75%.Multipleregressionanalysisshowedthatleptinhadapositivecorrelationwithqistagnationandbloodstasissyndrome(β=0.703,P<0.05)andcoldanddampnessobstructionsyndrome(β=0.476,P<0.05),whileithadanegativecorrelationwithdamp-heatobstructionsyndrome(β=-0.374,P<0.05).CD4+/CD8+ratiohadapositivecorrelationwithcoldanddampnessobstructionsyndrome(β=0.831,P<0.05)andqistagnationandbloodstasissyndrome(β=0.608,P<0.05),whileithadanegativecorrelationwithdamp-heatobstructionsyndrome(β=-0.483,P<0.05).

Conclusion:Thereisacertaincorrelationbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRA,whichprovidesacertainreferencevalueforthediagnosisandtreatmentofTCMsyndromedifferentiationRheumatoidarthritis(RA)isacomplexautoimmunediseasethataffectsmultiplesystemsinthebody.TraditionalChineseMedicine(TCM)hasbeenwidelyusedinthetreatmentofRA,andthesyndromedifferentiationplaysacrucialroleinthetreatment.However,thecorrelationsbetweenTCMsyndromedifferentiationandimmunesystembiomarkersarenotwellstudied.

Inthisstudy,weinvestigatedthecorrelationsbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRA.Ourresultsshowedthatleptinlevelsweresignificantlyhigherinpatientswithqiandblooddeficiencysyndromethaninthosewithothersyndromes.CD4+/CD8+ratiohadpositivecorrelationswithcoldanddampnessobstructionsyndromeandqistagnationandbloodstasissyndrome,whileithadanegativecorrelationwithdamp-heatobstructionsyndrome.

Leptinisahormonethatisinvolvedinregulatingenergybalanceandimmunesystemfunction.IthasbeenreportedtobeelevatedinRApatientsandtobeassociatedwithdiseaseactivity.OurstudyfurtherdemonstratedtheassociationbetweenleptinandTCMsyndromedifferentiationinRA.ItsuggeststhatmeasuringleptinlevelsmaybeausefultoolinTCMsyndromedifferentiationandtreatmentofRA.

CD4+/CD8+ratioisanotherimportantbiomarkerthatreflectsimmunesystemfunction.IthasbeenreportedtobealteredinRApatientsandtobeassociatedwithdiseaseseverity.OurstudyshowedthatCD4+/CD8+ratiowascorrelatedwithTCMsyndromedifferentiationinRA.Thepositivecorrelationwithcoldanddampnessobstructionsyndromeandqistagnationandbloodstasissyndromemayindicateimmunesystemdeficiencyandstagnation,whilethenegativecorrelationwithdamp-heatobstructionsyndromemayindicateimmunesystemactivation.

Inconclusion,ourstudyrevealedthecorrelationsbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRA.ItprovidesacertainreferencevalueforthediagnosisandtreatmentofTCMsyndromedifferentiation.FurtherstudiesareneededtovalidatethesefindingsandtoexploretheunderlyingmechanismsInadditiontothecorrelationsbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRA,thereareotherfactorsthatmayinfluenceTCMsyndromedifferentiationinRA.Forexample,oxidativestressandinflammationhavebeenreportedtobeassociatedwithTCMsyndromedifferentiationinRApatients(Wangetal.,2020).Oxidativestressandinflammationcancausetissuedamageanddysfunction,leadingtothedevelopmentofTCMsyndromessuchasbloodstasisandQistagnation.Ontheotherhand,TCMtreatmentsthataimatimprovingbloodcirculationandrelievingQistagnation,suchasacupunctureandherbalmedicine,havebeenfoundtoreduceoxidativestressandinflammationinRApatients(Wangetal.,2020).

Furthermore,gutmicrobiotadysbiosishasbeenimplicatedinthepathogenesisofRAandhasbeenlinkedtoTCMsyndromedifferentiationinRApatients(Shietal.,2020).TCMviewsthegutastheoriginofQiandbloodproduction,andgutmicrobiotadysbiosiscanleadtothedevelopmentofTCMsyndromessuchasdamp-heatandphlegm-dampness.Furthermore,TCMtherapiesthattargetgutmicrobiota,suchasprobioticsandherbalmedicine,havebeenfoundtoimproveTCMsyndromedifferentiationandreducediseaseactivityinRApatients(Shietal.,2020).

Inadditiontotheabovefactors,lifestylefactorssuchasdiet,exercise,andstressmanagementcanalsoinfluenceTCMsyndromedifferentiationinRA.Forexample,adietrichinanti-inflammatoryfoodssuchasfruits,vegetables,andomega-3fattyacidscanhelpalleviateTCMsyndromessuchasheat-toxicityandQistagnation(Zhangetal.,2020).RegularexercisehasalsobeenfoundtoimproveTCMsyndromedifferentiationandreducediseaseactivityinRApatients(Zhangetal.,2020).Finally,stressmanagementtechniquessuchasmeditation,yoga,andtaichicanhelpalleviateTCMsyndromessuchasQistagnationandbloodstasis(Zhangetal.,2020).

Insummary,TCMsyndromedifferentiationinRAisacomplexandmultifactorialprocessthatinvolvesvariousfactorssuchasleptin,CD4+/CD8+ratio,oxidativestress,inflammation,gutmicrobiota,andlifestylefactors.Ourstudyprovidesapreliminaryunderstandingofthecorrelationsbetweenleptin,CD4+/CD8+ratioandTCMsyndromedifferentiationinRA,butfurtherstudiesareneededtovalidatethesefindingsandexploretheunderlyingmechanisms.AcomprehensiveandpersonalizedapproachthattakesintoaccountallofthesefactorsmaybenecessarytoachieveoptimalTCMsyndromedifferentiationanddiseasemanagementinRApatientsInadditiontothefactorsmentionedabove,psychologicalstresshasbeenshowntocontributetoRAdevelopmentandprogression.Chronicstressleadstothereleaseofstresshormones,suchascortisol,whichcansuppresstheimmunesystemandincreaseinflammation.ThiscanexacerbateRAsymptomsandleadtoincreasedjointdamage.

PoorguthealthisanotherfactorthatmayplayaroleinRA.Thegutmicrobiotahasbeenshowntohaveasignificantimpactonimmunefunctionandinflammation.Animbalanceinthegutmicrobiota,knownasdysbiosis,canleadtoincreasedinflammationandexacerbationofRAsymptoms.Therefore,optimizingguthealththroughdiet,probiotics,andotherinterventionsmaybebeneficialinmanagingRA.

LifestylefactorsalsoplayaroleinRA.Smoking,forexample,hasbeenshowntoincreasetheriskofdevelopingRAandcanalsoworsendiseaseseverity.MaintainingahealthyweightandengaginginregularphysicalactivitymayalsohelptoimproveRAsymptomsandoverallhealth.

Inconclusion,amultidimensionalapproachthattakesintoaccountstress,inflammation,guthealth,andlifestylefactorsmaybenecessarytooptimizeTCMsyndromedifferentiationanddiseasemanagementinRApatients.Furthe