类风湿关节炎患者外周血血小板参数变化与Th17调节性T细胞及疾病活动的相关性分析

Changes of peripheral blood platelet parameters,Th17,Treg and disease activity in patients with rheumatoid arthritis:a correlation study

目的探讨类风湿关节炎(RA)患者的血小板参数与红细胞沉降率(ESR)、C反应蛋白(CRP)、28个关节疾病活动指数(DAS28)、抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、Th17及调节性T细胞之间的关系。方法收集2015年1月至2018年4月符合入排标准的山西医科大学第二医院风湿免疫科门诊及住院RA患者病历资料234例及健康人群77名。分析2组人群上述指标的差异以及RA组血小板计数(PLT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)与ESR、CRP、抗CCP抗体、RF、调节性T细胞相关性。计量资料符合正态分布且方差齐时采用两独立样本的t检验,不符合正态分布时采用Manil-Whitney秩和检验,采用Spearman行相关性分析。结果 (1) RA组PLT、MPV高于健康对照组,PDW低于对照组,2组差异均有统计学意义(P<0.01);(2) RA组调节性T细胞稍低于对照组,2组间比较差异无统计学意义;Th17高于对照组,2组差异有统计学意义(P<0.05);Th17/调节性T细胞低于对照组,2组差异有统计学意义(P<0.01);(3) RA组外周血各项血小板参数与调节性T细胞、抗CCP无相关性;PLT与Th17、Th17/调节性T细胞、RF、ESR、CRP、DAS28呈正相关;MPV与Th17、Th17/调节性T细胞、ESR、CRP呈负相关,与RF、DAS28无相关性;PDW与Th17、Th17/调节性T细胞、ESR、CRP呈负相关,与RF、DAS28无相关性。结论 RA患者外周血血小板参数不仅与病情活动有明确关联,而且其数值的变化与Th17、调节性T细胞的失衡有关。

Objective To investigate the correlation between platelet parameters and ESR, CRP, DAS28, anti-CCP antibody, RF, Th17 and Treg in patients with rheumatoid arthritis (RA). Methods The clinical data of 234 RA in-patients or out-patients and 77 healthy individuals registered to the Department of Rheumatology and Immunology, Second Hospital of Shanxi Medical University between January 2015 and February 2018 were included in the study. The differences in these indicators between the two groups, and the correlation between PLT, MPV, PDW and ESR, CRP, anti-CCP antibody, RF, Th17 and Treg in RA group were analyzed. When the measurement data was normally distributed and the variance was equal, the t-test of two independent samples was used; otherwise, Mann-Whitney U test was used. Spearman correlation was determined, and P<0.05 was considered statistically significant difference. Results ① The PLT and MPV in the RA group were higher than those in the healthy control group, whereas the PDW in the RA group was lower than that in the control group, with statistically significant differences between the two groups (all P<0.001).② The Treg in the RA group was slightly lower than that in the control group, without statistical significance between the two groups. The Th17 in the RA group was higher than that in the control group, with statistically significant difference between the two groups (P<0.05). The Th17/Treg in the RA group was lower than that in the control group, with statistically significant difference between the two groups (P<0.01).③ There were no correlations between platelet parameters and Treg and anti-CCP in peripheral blood of RA group; PLT was positively correlated with Th17, Th17/Treg, RF, ESR, CRP and DAS28; MPV was negatively correlated with Th17, Th17/Treg, ESR and CRP, but not anyway with RF and DAS28; PDW was negatively correlated with Th17, Th17/Treg, ESR and CRP, but not anyway with RF and DAS28. Conclusion The peripheral blood platelet parameters in RA patients are not only correlated with the disease activity; the changes of their values are related to the imbalance of Th17 and Treg cells.