基于BTLA及调节T细胞探讨294例风湿病患者血小板病变机制

To Investigate the Pathological Mechanism of Platelets in 294 Rheumatisants based on BTLA and Regulatory T Cells

目的:探讨B、T淋巴细胞衰减因子(BTLA)和调节性T细胞(Treg)在风湿病患者血小板病变中的作用机制。方法:选取294例风湿病患者,包括类风湿关节炎116例、强直性脊柱炎60例、干燥综合征56例、骨关节炎62例,采用流式细胞术检测患者外周血BTLA、Treg表达,采用生化仪检测风湿病患者血小板参数及实验室指标,观察风湿病患者血小板参数变化及与BTLA、Treg等实验室指标的关系。结果:①与正常组比较,风湿病患者血小板异常率最高为类风湿关节炎,其次为强直性脊柱炎、干燥综合征、骨关节炎;②与正常人群比较,风湿病患者外周血BTLA、Treg表达降低(P<0.05);与风湿病BTLA、Treg正常组比较,BTLA、Treg异常组血小板参数血小板计数(PLT)、血小板压积(PCT)、血小板分布宽度(PDW)升高(P<0.05或P<0.01);③相关分析显示:PLT、MPV与CD3+BTLA+Tcell呈正相关,PCT、PDW与CD4+BTLA+T cell、CD8+BTLA+T cell呈负相关,PLT与Treg、C3、红细胞沉降率(ESR)、hs-CRP呈正相关,MPV与IgG、ESR呈正相关,PDW与hs-CRP呈正相关(P<0.05或P<0.01)。结论:BTLA、Treg表达失衡,促使T细胞、B细胞过度异常活化,导致炎症因子失衡,造成血液系统的损害,从而出现RA血小板异常。

Objective：To investigate the mechanism of B,T lymphocyte attenuator （ BTLA ） and regulatory T cells （ Treg ） in the pathological changes of platelets in patients with rheumatic disease Methods：294 cases with rheumatic diseases were chosen,including 116 cases with rheumatoid arthritis,60 cases with ankylosing spondylitis,56 cases with sjogren syndrome and 62 cases with osteoarthritis.The peripheral blood BTLA and the Treg expressions were detected by flow cytometry, and platelet parameters and laboratory index of the patients with rheumatic diseases were detected by biochemical instrument,observing the change of parameters of platelets and its relationship with other laboratory indicators such as BTLA and Treg.Results： （1） Compared with the normal group,the abnormal rate of platelet was highest in patients with rheumatic disease,followed by ankylosing spondylitis,sj6gren syndrome and osteoarthritis; （2） Compared with the healthy,peripheral blood BTLA and Treg expression in rheumatism patients decreased （ P 〈 0.05 ） ;compared with BTLA,Treg normal group with rheumatic disease,the PLT, PCT and PDW of the BTLA,Treg abnormal group increased （ P 〈 0.05 or P 〈 0.01 ） ;（3） Correlation analysis showed that PLT, MPV were positively correlated with CD3＋BTLA＋T cell; PCT, PDW were negatively correlated with CD4＋BTLA＋T cell and CD8＋BTLA＋T cell;PLT was positively correlated with Treg,C3,erythrocyte sedimentation rate （ ESR ） ,hs-CRP;MPV was positively correlated with IgG,ESR;and PDW was positively correlated with hs- CRP （P 〈 0.05 or P 〈 0.01 ） .Conclusion：The imbalance of the expression of BTLA and Treg promoted the abnormal activation of T cell and B cell,leading to the imbalance of inflammatory factors,resulting in the damage of blood system,thus the abnormalities of rheumatoid arthritis platelets.