类风湿关节炎患者血小板参数变化可能与BTLA、Treg表达失衡有关  

On the Probable Relationship between the Changes of Platelet Parameters and the Imbalanced Expressions of BTLA and Treg in Patients with Rheumatoid Arthritis

作　　者：朱福兵 刘健[2] 方利[1] 谈冰[1] 章平衡 

机构地区：[1]安徽中医药大学,安徽合肥230038 [2]安徽中医药大学第一附属医院,安徽合肥230031

出　　处：《风湿病与关节炎》2016年第7期15-19,23,共6页Rheumatism and Arthritis

基　　金：国家临床重点专科中医风湿病科建设项目(财社〔2013〕239号);国家中医药重点学科中医痹病学建设项目(国中医药发〔2009〕30号);"十二五"国家科技支撑计划项目(2012BA126B02);安徽省重点实验室建设项目(1306c083035);安徽省科技计划项目(11010402170)

摘　　要：目的:观察类风湿关节炎(RA)患者血小板参数和B、T淋巴细胞衰减因子(BTLA)和调节性T细胞(Treg)的变化,并初步探讨其机制。方法:选取604例RA患者及60例健康者分别为RA组和正常对照组。采用全血细胞计数仪测定患者血小板计数(PLT)、血小板比容(PCT)、血小板分布宽度(PDW)、血小板平均容积(MPW);采用流式细胞术检测外周血BTLA、Treg表达频率;采用魏氏法测定红细胞沉降率(ESR),全自动生化仪测定免疫球蛋白(Ig)、超敏C-反应蛋白(hs-CRP)等炎症指标,并计算关节疾病活动度评分(DAS28)。结果:1 604例RA患者血小板参数至少一项异常者367例(60.96%),2项同时异常者181例(29.97%),3项同时异常者55例(9.11%),4项全部异常者12例(1.99%)。2与正常对照组比较,RA患者ESR、hs-CRP、类风湿因子(RF)、抗CCP抗体、DAS28、IgM、IgG明显升高,外周血BTLA、Treg表达频率显著降低(P<0.01或P<0.05);3与血小板参数正常组比较,血小板参数异常组病程、PLT、PCT、MPV、ESR、RF、hs-CRP、抗CCP抗体、IgG明显升高,BTLA、Treg明显降低(P<0.01或P<0.05);4相关性分析显示,RA患者PLT与DAS28、ESR、hs-CRP、抗CCP抗体、IgG、Treg呈正相关,与BTLA呈负相关;PCT与ESR、hs-CRP、RF、IgM呈正相关,与BTLA、Treg呈负相关;PDW与ESR、CCP呈正相关,与BTLA呈负相关;MPV与RF呈正相关,与BTLA、Treg呈负相关(P<0.01或P<0.05)。结论:RA患者普遍存在血小板参数的异常,且与疾病的活动度显著相关,伴有血小板参数升高的RA患者病情更重,疾病活动度较高,其机制可能与BTLA或Treg表达减少,导致机体免疫紊乱,炎症因子表达失衡,造成血液系统损伤有关。[ABSTRACT]Objective：To observe the probable relationship between the changes of platelet parameters and the imbalanced expressions of B,T lymphocyte attenuation factor（BTLA）and Treg in patients with rheumatoid arthritis（RA）and to explore the mechanism of them.Methods：Six hundred and four RA patients and sixty healthy people were selected as a RA group and a normal control group.The blood counting instrument was used to determine the blood platelet count（BPC）,thrombocytocrit,platelet distribution width（PDW） and mean platelet volume（MPV）.The lfow cytometry was used to detect the expression frequency of BTLA and Treg in outer peripheral blood.And the Westergren method was used to determine the erythrocyte sedimentation rate（ESR）.The immunoglobulin（Ig）and high-sensitivity C-reactive protein were measured by automatic biochemical analyzer,calculating activity score（DAS28）of joint diseases.Results：① Out of the 604 cases,367 cases were abnormal in at least 1 parameter（60.96%）,181 cases were abnormal in both 2 parameters（29.97%）,55 cases were abnormal in 3 parameters（9.11%）,and 12 cases were abnormal in all the 4 cases（1.99%）.② Compared with the normal control group,the ESR,hs-CRP,rheumatoid factor（RF）,anti CCP antibody and IgG in RA patients increased signiifcantly,while the expression frequency of BTLA and Treg in outer peripheral blood decreased obviously（P〈 0.01 orP〈 0.05）.③ Compared with the normal control group,the course of disease,BPC,thrombocytocrit,MPV,ESR,RF,hs-CRP,anti CCP antibody and IgG of those with abnormal platelet parameters increased obviously,and their BTLA and Treg decreased signiifcantly （P〈 0.01 orP〈 0.05）.④ The correlation analysis showed that BPC of RA was positively correlated with DAS28,ESR,hs-CRP,anti CCP antibody,IgG,and Treg and negatively related with BTLA.Thrombocytocrit was positively correlated with ESR,hs-CRP,RF and IgM and negatively correlated with Treg and BTLA（P〈 0.01 or P〈 0.05）.Conclusion：

关 键 词：关节炎 类风湿 血小板参数 BTLA TREG 

分 类 号：R593.22[医药卫生—内科学]