血小板生成素和转化生长因子-β_1与儿童特发性血小板减少性紫癜的相关性研究

A study on thrombopoietin and transforming growth factor-beta 1 in children with idiopathic thrombocytopenic purpura

目的 研究特发性血小板减少性紫癜 (ITP)患儿血小板生成调控因子的变化。方法 采用双抗体夹心酶联免疫吸附法 (ELISA)定量检测了 2 0 0 0年 1月至 2 0 0 1年 12月山东大学齐鲁医院儿科收治的 4 5例急性ITP患儿治疗前后血清和骨髓上清液中血小板生成素 (TPO)和转化生长因子 β1(TGF β1)水平。结果 ( 1)ITP患儿治疗前血清TPO水平高于正常对照组 ,但差异无显著性 ;治疗前TGF β1水平明显高于对照组 (P <0 0 1)。 ( 2 )经过激素治疗缓解后血清TPO水平较治疗前有所降低 ,但差异无显著性。治疗反应差者治疗前血清TPO水平较治疗反应好者显著升高 ( P <0 0 1) ,并高于对照组 ( P <0 0 1)。缓解后血清TGF β1水平与治疗前相比无明显下降 (P >0 0 5 )。 ( 3)治疗前骨髓上清液中TPO和TGF β1水平均高于对照组 (P <0 0 1) ,并明显高于同期血清水平 (P <0 0 1) ,且和血清中的TPO和TGF β1水平呈正相关。 ( 4 )ITP患儿血小板数目低时 ,TPO水平偏高 ;治疗后血小板数回升时 ,TPO水平有所降低 ,TPO水平与血小板数呈负相关 (r =- 0 6 4 9,P <0 0 5 ) ,同时和巨核细胞数也呈负相关 (r =- 0 5 19,P <0 0 5 )。结论 血清、骨髓上清液中TPO、TGF β1水平的检测可为ITP患儿的病情判断、估计预后。

Objective To explore the relationship between thrombopoietin(TPO),transforming growth factor beta 1(TGF β 1 ) and idiopathic thrombocytopenic purpura(ITP).Methods TPO and TGF β 1 levels in the serum and bone marrow of 45 children with ITP were detected using enzyme linked immunosorbent assay(ELISA).Results (1)The serum level of TPO in ITP children was higher than controls,but had no significant difference.The serum level of TGF β 1 in ITP children was much higher than controls(P<0 01).(2)The serum level of TPO after therapy was slightly lower than before treatment.Some ITP children having a poor response to steroids had a significantly higher serum TPO level than in those having good response and controls(P<0 01).(3)The bone marrow level of TPO and TGF β 1 was higher than normal(P<0 01)and also higher than the serum level(P<0 01).There was positive correlation between serum level and bone marrow level.(4)Before treatment,ITP children had low platelet count but high level of TPO.After treatment,when platelet count increased,the level of TPO reduced.There were negative correlation between TPO and platelet count(r=-0 649,P<0 05),and between TPO and megakaryocyte count(r=-0 519,P<0 05).Conclusion In the mechanism of ITP,TGF β 1 was a feedback modulating factor.The level of TPO and TGF β 1 in the serum and bone marrow could help evaluate ITP children’s condition,estimate prognosis and enact the treatment.