| Objective: Immune thrombocytopenia (ITP) is an acquired organ-specific autoimmune disease in which platelets are opsonized by autoantibodies and destroyed by macrophages, is typical autoimmune disease mediated by B-cell. The autoimmune hemolytic anemias (AIHA) are a group of disorders in with autoantibodies against antigens on the erythrocyte membrane cause a shortened red blood cell life span. BAFF(B-cell activating factor of the TNF family) is one of the tumour necrosis factor superfamily member(TNFsF) found in 1999. The role of BAFF have obvious B cell chemotaxis. In vitro, as a B cell proliferation and differentiation co- stimulatory factor, BAFFcan be combined with B lymphocytes and promoted their proliferation, differentiation, immunoglobulin secretion, participated organism's autoimmu-ne response. In vivo, can be mediated by peripheral immature B cells survival and to differentiated into mature B cells. Recombinant or endogenous BAFF stimulated T cells to secreted IFN-γ, and used IL-2 dependent style to promoted T cells proliferation, at anti-CD3 antibody activated T cells, BAFF up-regulated the expression of Bcl-2, suggesting BAFF is also a specific survival factor of actvated T cells. BAFF is one of the critical survival factor of B cell maturation checkpoint period, this stage producted too much can damaged self-tolerance of B cells, induced to autoimmune diseases, and producted too little lead to humoral immune defect,and associatd to humoral immune defect of common variant.many autoimmune diseases such as systemic lupus erythematosus,rheumatoid arthritis, Sjogren's syndrome, Wegener granulomas are detected elevated serum levels of soluble BAFF. Recent studies have found that elevated levels of serum BAFF in ITP patients, but few reports on the serum BAFF in ITP and AIHA patients. To further study the serum BAFF role in the effect of pathogenesis in patients with ITP and AIHA, this study measured levels of serum BAFF in ITP and AIHA patients, to further identify ITP and AIHA morbidity whether certain relationship and changes in their levels before and after treatment, and analysis correlation between serum BAFF and clinical index of hemoglobin levels, platelet levels, autoantibody levels, reticulocyte levels, Ig levels, CRP, RF, ASO, ESR levels. Initial discussed BAFF in the role of the two disases, for new ideas of diagnosis and treatment.Subjects and methods:(1)Subjects Samples were selected from 51 newly diagnosed and 24 relapsed and refractory ITP patients and 16 AIHA patients in the Second Hospital of Hebei Medical University from March 2010 to February 2011; subjects were divided into six groups:①The newly diagnosed ITP group: 51cases, 17 Males and 34 Females, mean age 40Y, including 4 untreated patients.②After trentment ITP group: 51 patients from newly diagnosed ITP group after corticosteroids treatment in two weeks.③The relapsed and refractory ITP group: 24cases, 10Males and 14 famales, mean age 35.5Y, including relapsed ITP patient 20 cases, refractory ITP patient 4 cases.④The newly diagnosed AIHA group: 16cases, 6 Males and 10 Females, mean age 47.5Y.⑤After trentment AIHA group: 16 patients from newly diagnosed AIHA groups after corticosteroids treatment in two weeks.⑥The controls: collected from health check staff of examination center. 28cases, 14 Males and 14 cases, mean age 34Y. (2)Collecting the peripheral blood, extracted serum, and determined levels of serum BAFF use enzyme-linked immunosorbent assay(ELASA). Collected patient gender, Age, Ig, Hb, PLT, ANA, et al, laboratory paramerers. (3)the results were analyzed by SPSS13.0, data presented as±s, using t test to pairwise comparison, using One-way ANOVA to multiple comparison, and we established the standard of statistic significance asα=0.05.Results:1 The serum levels of BAFF in controls: 28 cases, The average expression levels of serum BAFF was: (1039±198) ng/L. 2 The serum levels of BAFF in newly diagnosed ITP patients: 51 cases, The average expression levels of serum BAFF was: (1363±299) ng/L. The newly diagnoesd group was higher than that in controls, had significant difference(P<0.05).3 The serum levels of BAFF after P.O corticosteroid treatment in newly diagnosed ITP patients(2W):(1) Patients with Plt counts≥100×10~9/L: 10 cases, BAFF levels of untreated and treated ITP patients were: (1425±276) ng/L, (891±107) ng/L. the level of BAFF in untreated group was significantly higher than that in after trentment group(P<0.05); there was no significant difference between treated group and controls(P>0.05).(2) Patients with 100×10~9/L>Plt counts>50×10~9/L: 4 cases, BAFF levels of untreated and treated ITP patients were: (1417±130) ng/L, (1156±108) ng/L. the level of BAFF was no significant difference between untreated group and treated group(P>0.05); There was no significant difference between treated group and controls(P>0.05).(3) Patients with Plt counts≤50×10~9/L: 2 cases, BAFF levels of untreated and treated ITP patients were: (1613±383) ng/L, 1306(1296±189) ng/L. BAFF levels have no significant difference between untreated and treated ITP patients (P>0.05), but significantly higher than that in controls(P<0.05).4 The serum levels of BAFF after i.v.gtt High-dose corticosteroid treatment in newly diagnosed ITP patients(2W):(1) Patients with Plt counts≥100×10~9/L: 27 cases, BAFF levels of untreated and treated ITP patients were: (1366±332) ng/L, (935±221) ng/L. The level of BAFF in untreated group was significantly higher than that in after trentment group(P<0.05); there was no significant difference between treated group and controls(P>0.05).(2) Patients with 100×10~9/L>Plt counts>50×10~9/L: 3 cases, BAFF levels of untreated and treated ITP patients were: (1517±136) ng/L, (1271±150) ng/L. The level of BAFF was no significant difference between untreated group and treated group(P>0.05); there was no significant difference between treated group and controls(P>0.05).(3) Patients with Plt counts≤50×10~9/L: 1 cases, BAFF levels of untreated and treated ITP patients were: 1513 ng/L, 1306 ng/L. BAFF levels appeared falling tendency after treatment, but was still significantly higher than the controls.5 The serum levels of BAFF after P.O corticosteroid and High-dose corticosteroid treated are: (1008±194) ng/L, (978±230) ng/L, had on significant difference(P>0.05).6 The serum levels of BAFF after corticosteroid treated in relapsed ITP patients: 20 cases, BAFF levels of relapsed ITP patients was: (1286±278) ng/L. There was no significant difference between relapsed ITP patients and that in newly diagnosed ITP patients(P>0.05).7 The serum levels of BAFF in refractory ITP patients: 4 cases, BAFF levels of untreated and treated ITP patients were:(1402±299)ng/L, (1223±173)ng/L. There was no significant difference between untreated and treated ITP patients(P>0.05), also had no significant difference between newly diagnosed ITP and refractory ITP patients(P>0.05).8 The serum levels of BAFF in untreated ITP patients was: 4cases, (1169±171) ng/L, two weeks later, the serum levels of BAFF was: (1038±92)ng /L. There was no significant difference between untreated and controls(P>0.05).9 The serum levels of BAFF in newly diagnosed AIHA patients: The average expression levels of serum BAFF was: (1574±286)ng/L. The newly diagnoesd group was higher than that in controls, had significant difference(P<0.05).10 The serum levels of BAFF after i.v.gtt High-dose corticosteroid treated AIHA patients(2W):(1) Hb counts≥110g/L after treated AIHA patients:BAFF levels of untreated and treated in patients were: 9cases, (1478±295) ng/L, (840±183) ng/L. untreated AIHA was significantly higher than that in treated AIHA(P<0.05); there was significantly higher than that in controls(P<0.05). (2) 110g/L>Hb counts>80g/L after treated AIHA patients: 5 cases, BAFF levels of untreated and treated in patients were: 5cases, (1684±255) ng/L, (1052±191) ng/L. Untreated AIHA was significantly higher than that in treated AIHA(P<0.05); there was no significant difference between treated ITP and controls(P>0.05).(3) Hb counts≤80g/L after treated AIHA patients:BAFF levels of untreated and treated in patients were: 2cases, (1727±276) ng/L, (1423±140) ng/L. BAFF levels had no significant difference between untreated and treated ITP patients(P>0.05), but significantly higher than controls(P<0.05).11.There was no correlation between BAFF and patients gender, age, Ig levels, Hb levels, Plt levels, Ret levels, ANA levels, CRP, RF, ASO, ESR: In ITP patients had not found the correlation between BAFF levels and gender, age, Plt levels, Ig levels, ANA, CRP, RF, ASO, ESR levels. In AIHA patients had not found the correlation between BAFF levels and gender, age, Hb levels, Ret levels, Ig levels, ANA, CRP, RF, ASO, ESR levels.Conclusion:1 The serum levels of BAFF have signifcant difference between in newly diagnosed ITP group, relapsed and refractory ITP group; newly diagnosed ITP group and relapsed and refractory ITP group have no significant difference. After trentment ITP group have no sigificant difference(excepted untreated ITP patient).2 The serum levels of BAFF in Uutreated and treated refractory ITP patients, after corticosteroid treated have no siginificant difference, but is higher than controls.3 Untreated and treated ITP patients with Plt counts<100×10~9/L after corticosteroid treated have no siginificant difference, but is higher than controls.4 The serum levels of BAFF in ITP patients after P.O corticosteroid and i.v.gtt corticosteroid have no significant difference. 5 The serum levels of BAFF have signifcant difference between newly diagnosed group and after trentment AIHA patients; there is no sigificant difference between in reture diagnosed AIHA and controls.6 Untreated and treated AIHA patients with Hb counts<80g/L after corticosteroid treated have on siginificant difference, but is higher than controls. BAFF levels have vary degrees decrease after immunosuppressive treatment; serum BAFF maybe play a important role in the pathogenesis of ITP and AIHA.7 We have not found the correlation between BAFF levels and gender, age, Plt levels, Ig levels, ANA, CRP, RF, ASO, ESR levels. In AIHA patients have not found the correlation between BAFF levels and gender, age, Hb levels, Ret levels, Ig levels, ANA, CRP, RF, ASO, ESR levels. We speculated that can not based on Plt levels, Hb levels and other laboratory data to determine the levels of BAFF, pure elevated levels of BAFF not reflected severe levels of diseases.8 Determinated of BAFF levels in patients with ITP and AIHA maybe provided the basis for disease process, medication, prognosis evaluation.
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