Qian Hongyan, Chen Rongjuan, Wang Bin, Yuan Xiaoqing, Chen Shiju, Liu Yuan, Shi Guixiu
Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
School of Medicine, Xiamen University, Xiamen, China.
Front Pharmacol. 2020 Nov 6;11:559593. doi: 10.3389/fphar.2020.559593. eCollection 2020.
Increased platelet count has been reported in ankylosing spondylitis (AS) patients, but its clinical significance is still largely elusive. The objective of this study was to evaluate the clinical role of platelet count in AS patients, especially its impact on treatment outcomes. A case-control study containing 35 AS patients receiving anti-tumor necrosis factor-α (anti-TNF-α) therapy and 45 healthy controls was performed, and AS patients were followed at least 6 months after anti-TNF-α therapy. A systematic review and meta-analysis of studies containing relevant data on outcomes of interest was also performed. AS patients had significantly higher platelet count than controls ( = 0.0001), and the significantly increased platelet count in AS patients was confirmed in a meta-analysis of 14 studies involving 1,223 AS patients and 913 controls (mean difference = 39.61, 95% CI 27.89-51.34, < 0.001). Besides, platelet count was significantly correlated with ESR ( < 0.001) and was moderately correlated with ASDAS-CRP score ( = 0.002). Moreover, anti-TNF-α therapy could reduce platelet count in AS patients at the first month and the effect was maintained through the treatment duration. In the prospective follow-up study of those 35 AS patients, those responders to anti-TNF-α therapy had significantly lower platelet count than nonresponders ( = 0.015). Logistic regression analysis suggested that lower platelet count was associated with higher possibility of achieving good response to anti-TNF-α therapy in AS patients (odds ratio = 2.26; 95% CI = 1.06-4.82; = 0.035). This study suggested that platelet count was associated with inflammation severity and treatment outcomes in AS patients, and elevated platelet count was a promising biomarker of poorer response to anti-TNF-α therapy. The findings above need to be validated in more future studies.
已有报道称强直性脊柱炎（AS）患者的血小板计数升高，但其临床意义仍 largely 难以捉摸。本研究的目的是评估血小板计数在 AS 患者中的临床作用，尤其是其对治疗结果的影响。进行了一项病例对照研究，纳入 35 例接受抗肿瘤坏死因子-α（抗 TNF-α）治疗的 AS 患者和 45 例健康对照，并且在抗 TNF-α治疗后对 AS 患者进行至少 6 个月的随访。还对包含有关感兴趣结局的相关数据的研究进行了系统评价和荟萃分析。AS 患者的血小板计数显著高于对照组（ = 0.0001），在一项涉及 1223 例 AS 患者和 913 例对照的 14 项研究的荟萃分析中证实了 AS 患者血小板计数显著升高（平均差异 = 39.61，95%CI 27.89 - 51.34， < 0.001）。此外，血小板计数与血沉显著相关（ < 0.001），与 ASDAS-CRP 评分中度相关（ = 0.002）。而且，抗 TNF-α治疗在第一个月可降低 AS 患者的血小板计数，并且该效果在整个治疗期间得以维持。在对这 35 例 AS 患者的前瞻性随访研究中，那些对抗 TNF-α治疗有反应者的血小板计数显著低于无反应者（ = 0.015）。逻辑回归分析表明，较低的血小板计数与 AS 患者对抗 TNF-α治疗获得良好反应的可能性较高相关（比值比 = 2.26；95%CI = 1.06 - 4.82； = 0.035）。本研究表明血小板计数与 AS 患者的炎症严重程度和治疗结果相关，血小板计数升高是对抗 TNF-α治疗反应较差的一个有前景的生物标志物。上述发现需要在更多未来研究中得到验证。
