Association Between SIBO-like Gut Microbiota Imbalance and Peripheral Blood Lymphocyte Subsets as well as Disease Activity in Patients with Rheumatoid Arthritis

GOU Wei; ZHANG Yu; DONG Huan; LUAN Xiaqing; HAO Jianan; SHEN Liying

doi:10.3639/j.issn.2095-3097.2025.12.020

Abstract：Objective To explore the association between small intestinal bacterial overgrowth(SIBO)-like gut microbiota imbalance and peripheral blood lymphocyte subsets as well as disease activity in patients with rheumatoid arthritis(RA).Methods A total of 80 RA patients admitted to Hebei PetroChina Central Hospital between June 2021 and June 2023 were retrospectively selected.Based on methane-hydrogen breath test results at admission,which served as the diagnostic criterion for SIBO-like gut microbiota imbalance,patients were divided into a gut microbiota imbalance group(36 cases)and a non-gut microbiota imbalance group(44 cases).Baseline characteristics,peripheral blood lymphocyte percentage(LYM%),lymphocyte subsets(CD3+,CD4+,CD8+),autoantibody profiles[rheumatoid factor(RF),anti-cyclic citrullinated peptide(CCP)antibody,anti-keratin antibody(AKA)],and disease activity score(DAS28)were compared between the two groups at admission.Receiver operating characteristic(ROC)curve analysis was used to examine the relationship between gut microbiota imbalance and peripheral blood LYM%,lymphocyte subsets,autoantibody indicators,and disease activity in RA patients at admission.Pearson correlation analysis was employed to assess the relationship between DAS28 score and peripheral blood lymphocyte subset levels in RA patients with gut microbiota imbalance.ROC curve analysis was also used to evaluate the predictive value of each indicator for gut microbiota imbalance.Results The gut microbiota imbalance group had significantly lower levels of LYM%,CD3+,and CD8+,but a higher CD4+level compared to the non-gut microbiota imbalance group(P<0.05).Additionally,the gut microbiota imbalance group showed higher levels of RF,CCP,and AKA than the non-gut microbiota imbalance group(P<0.05).ROC curve analysis indicated that the areas under the curve for peripheral blood LYM%,CD3+,CD4+,CD8+,RF,CCP,AKA,and DAS28 score in predicting gut microbiota imbalance in RA patients were 0.770,0.788,0.693,0.801,0.705,0.780,0.718,and 0.684,respectively(P<0.05).Pearson correlation analysis revealed that in RA patients with gut microbiota imbalance,DAS28 score was positively correlated with CD3+and CD4+levels(r=0.373,0.500,P=0.025,0.002),and negatively correlated with CD8+level(r=-0.502,P=0.002).Conclusion Gut microbiota imbalance in RA patients is associated with multiple peripheral blood immune indicators and disease activity,and these indicators demonstrate good predictive value for microbiota imbalance.In patients with microbiota imbalance,DAS28 score shows weak to moderate correlations with lymphocyte subsets,suggesting that gut microbiota may be involved in the immunopathological process of RA by modulating the balance of T cell subsets.