成人特发性血小板减少性紫癜糖皮质激素受体研究的临床意义

Study of glucocorticoid receptors in adult diopathic thrombocytopenic purpura

目的探讨糖皮质激素受体(GR)在成人特发性血小板减少性紫癜(ITP)患者外周血淋巴细胞中的表达以及预测糖皮质激素(GC)疗效的价值。方法采用电化学发光免疫法测定30例ITP患者治疗前的血清皮质醇水平,以及流式细胞术测定GC治疗前后外周血淋巴细胞GC的细胞内受体(iGR)与膜受体(mGR)水平。结果急性ITP和慢性ITP患者治疗前淋巴细胞mGR、iGR均高于正常对照组(P<0.05)。激素敏感组和激素抵抗组治疗前淋巴细胞mGR、iGR均高于正常对照组(P<0.05)。治疗前激素敏感组iGR水平明显高于激素抵抗组(P<0.05)。激素敏感组iGR治疗后高于治疗前(P<0.05),激素抵抗组iGR治疗后低于治疗前(P<0.05)。激素敏感组与激素抵抗组之间治疗前后的iGR变化差异有统计学意义(P<0.05)。结论 iGR的水平可以作为激素治疗成人ITP疗效的观察指标之一。

Objective To study the expression of glucocorticoid receptors （GR）in peripheral blood lymphocytes and to investigate the prognostic value of glucocorticoid in adult patients with idiopathic thrombocytopenic purpura （ITP）. Methods Thirty patients with ITP were included. The level of serum hydrocortisone was detected by electrochemineseence immunoassay before treatment and the expressions of membranelas-sociated glucocorticoid receptor （ mGR ） and intracellular glucocorticoid （ iGR ） in peripheral blood lymphocytes were detected by flow cytometry at predose and postdose stage. Results The expressions of both mGR and iGR were higher in acute and chronic ITP adult patients than in normal control（ P 〈 0. 05 ）. The expressions of both mGR and iGR level was higher in GC sensitive ITP adult patients and those of GC resistant than in normal control（ P 〈 0. 05 ）. The iGR level was significantly higher in GC sensitive ITP adult patients than those of GC resistant（P 〈 0. 05 ）. The expressions of iGR were higher in GC sensitive ITP adult patients postdose than those predose （ P 〈 0. 05 ）. The expressions of iGR were lower in GC resistant adult patients post-treatment than those at predose （P 〈 0. 05）. Conclusions The level of iGR is related to the effect of GC therapy, and it could be used as a reference marker for the＇evaluation of therapeutic effect in adult patients with ITP.