Detection and clinical significance of plasma cytokines in systemic juvenile idiopathic arthritis
Objective To investigate the changes of different cytokines in systemic juvenile idiopathic arthritis(SJIA)and their role in early diagnosis.Methods A retrospective study was conducted to select pediatric patients with fever accompanied by elevated levels of CRP,erythrocyte sedimentation rate(ESR),and ferritin who visited the Department of Renal Immunology,Children's Hospital of Soochow University from November 2019 to January 2023.Compare the differences in CRP,ESR,ferritin,and 34 plasma cytokines levels between children with SJIA and other autoimmune diseases.Cytokine risk was analyzed by regression;Correlation analysis was performed to determine whether cytokines were associated with lymphocyte subsets and disease activity.Results During the study period,118 children with fever accompanied by elevated CRP,ESR and ferritin were eligible,among whom 20 children with SJIA were diagnosed,and 98 children with other autoimmune diseases were diagnosed.There was no statistically significant difference in CRP and ESR between SJIA patients and children with other autoimmune diseases(Z values were 0.721 and 0.345,all P＞0.05);There were significant differences in ferritin,IL-27,IL-17A,IL-31,IFN-γ,IL-18 between children with SJIA and those with other autoimmune diseases(Z values were 2.628,-2.052,-2.763,-2.135,4.067,4.419,all P＜0.05).Univariate Logistic regression analysis showed that IL-18(OR=1.003,95％CI:1.002～1.004,P＜0.001),IFN-γ(OR=1.004,95％CI:1.001～1.007,P=0.004),IL-27(OR=0.846,95％CI:0.716～0.999,P=0.049),IL-31(OR=0.657,95％CI:0.451～0.959,P=0.028)were closely related to the occurrence of SJIA,and stepwise Logistic regression analysis indicated that the increase of IL-18(OR=1.005,95％CI:1.003～1.009,P=0.004)increased the risk of SJIA,and the increase of IL-5(OR=0.619,95％CI:0.402～0.953,P=0.029)decreased the risk.IL-18(r=0.673,P=0.020),IL-27(r=0.486,P=0.041)and TNF-α(r=0.560,P=0.016)were positively correlated with the activity of SJIA.Conclusion IL-18 presents a characteristic cytokine positively correlated with the risk of SJIA,while IL-5 presents a protective cytokine against SJIA.Both cytokines have independent predictive power for the risk.
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