免疫性血小板减少性紫癜患者脾切除术前后外周血T细胞亚群的检测意义

Value for detection of peripheral blood T-lymphocyte subsets before and after splenectomy in patients with immune thrombocytopenic purpura

目的探讨免疫性血小板减少性紫癜(ITP)患者脾切除术前后外周血T淋巴细胞亚群及CD56+NKT细胞的变化及血液学疗效与各检测指标的关系。方法应用流式细胞技术,检测34例ITP患者腹腔镜脾切除术前后7d外周血T细胞亚群(CD3+、CD3+CD4+和CD3+CD8+)及CD56+NK细胞的百分数。根据不同的血液学疗效,将患者分为手术有效组(A组,22例)和无效组(B组,12例)。应用SPSS13.0forWindows软件对比分析两组术前后T细胞亚群、CD56+NK细胞的百分数及CD4+/CD8+比值的差异及各组术前后各指标的变化。结果 A组和B组术前CD3+CD4+细胞百分数分别为(32.83±8.07)%和(26.23±6.17)%(P=0.045),术前CD4+/CD8+比值分别为(1.30±0.51)和(0.84±0.42)(P=0.022)。余两组术前后各指标差异无统计学意义;B组术前后CD3+细胞百分数分别为(65.51±4.54)%和(60.38±12.97)%(P=0.017),CD3+CD8+细胞百分数分别为(37.27±12.47)%和(32.96±13.18)%(P=0.025)。余各组术前后各指标差异无统计学意义。结论脾切除疗效不同的ITP患者存在不同的细胞免疫发病机制。术前外周血CD3+CD4+细胞百分数及CD4+/CD8+比值有助于预测手术疗效。

Objective To investigate the T-lymphocyte subsets and CD56＋ NK T cells changes of peripheral blood before and after splenectomy,and the relationship between these variables and hematological outcomes in patients with immune thrombocytopenic purpura （ITP）.Methods Using flow cytometry technique,the percentages of T-lymphocyte subsets （including CD3＋,CD3＋CD4＋ and CD3＋CD8＋） and CD56＋ NK cells of peripheral blood were detected 7 days before and after laparoscopic splenectomy in 34 patients with ITP.The patients were then divided into splenectomy effective group （group A,22 cases） and splenectomy ineffective group （group B,12 cases） according to their hematological outcomes.The differences of the percentages of T-lymphocyte subsets and CD56＋ NK cells,and CD4＋/CD8＋ ratio between two groups,as well as the changes of these variables before and after operation in each group,were analyzed by the software of SPSS 13.0 for windows.Results The percentages of CD3＋CD4＋ cells before operation were （32.83±8.07）% in group A and （26.23±6.17）% in group B （P=0.045）.The CD4＋/CD8＋ ratios before operation were （1.30±0.51） in group A and （0.84±0.42） in group B （P=0.022）.There were no significant differences of other preoperative or postoperative variables between two groups.The percentages of CD3＋ cells before and after operation were （65.51±4.54）% and （60.38±12.97）% in group B,respectively （P=0.017）.And the percentages of CD3＋CD8＋ cells before and after operation were （37.27±12.47）% and （32.96±13.18）% in group B,respectively （P=0.025）.There were nosignificant differences of other variables between pre-operation and post-operation in each group.Conclusions There is different cellular immunopathogenesis in ITP patients with different responses to splenectomy.Preoperative detection of the percentages of CD3＋CD4＋ cells and CD4＋/CD8＋ ratio in peripheral blood is helpful to predict the outcome of operation.