儿童原发性免疫性血小板减少症初发病例T辅助细胞因子表达水平意义初探

Initial Study of T-Helper Cell Cytokines Level in Children Patient with Primary Immunne Thrombocytopenia During the Initial Episode

目的分析儿童原发性免疫性血小板减少症(ITP)初次发病时治疗前、后T辅助细胞因子分泌水平,探讨儿童ITP细胞免疫功能状态与预后的相关性。方法回顾性研究北京儿童医院血友病中心2011年12月～2012年8月收治的初次发病的儿童ITP病例,记录检查血清T辅助细胞因子的时间和首次接受一线治疗的时间,通过流式液相多重蛋白定量计数法测定T辅助细胞因子浓度,全部病例均于2012年11月进行电话随访,了解患儿入组后3个月内的血小板计数和临床出血情况。根据标本留取前的治疗情况及随访期间疾病缓解情况分为4组,即治疗前检测的缓解组、治疗前检测的未缓解/复发组、治疗后检测的缓解组及治疗后检测的未缓解/复发组。分别对治疗前、治疗后检测的缓解组与未缓解/复发组的细胞因子浓度进行比较。结果共收集病例43例,细胞因子检测前未接受治疗者5例,接受治疗者38例,缓解组共34例,未缓解/复发组共9例。①TH1细胞因子系列:治疗前检测的未缓解/复发组的IFN浓度比缓解组高,治疗后检测未缓解/复发组有较高水平的TNF、IL-2。②TH2细胞因子系列:治疗前检测未缓解/复发组的IL-4明显高于缓解组,治疗后检测的未缓解/复发组的IL-4仍高,同时IL-6浓度比缓解组高。结论未经治疗的ITP患儿体内高浓度IFN和IL-4可能提示疾病的迁延;而经一线治疗后TNF、IL-2、IL-4和IL-6的浓度升高可能提示治疗效果欠佳。因此T辅助细胞因子的检测可能对判断ITP的预后有一定的指导意义。

Objective To analyze the T-helper （TH） cell cytokines secretion level before or after the treatment in the initial episode of children＇ s immune thrombocytopenia （ITP） , study the relationship of cellular-immune function condition and the prognosis. Methods Retrospectively collected children＇ s ITP during early onset period in Hematology Center of Beijing Children＇ s Hospital in Dec. 2011 - Aug. 2012, record the date when patient was taken the blood sample and received the first-line therapy. Using the cytometric bead array to test TH cell cytokines level. All of the cases were followed through telephone in Nov. 2012, collect the platelet count and clinical manifestation during 3 months after enrollment. Divide the cases into 4 groups according to the treatment before of after the sample taken and remission： Remission group whose blood taken before therapy, non-remission/relapse group whose blood taken before therapy, remission group whose blood taken after therapy, non-remission/relapse group whose blood taken after therapy. Compare the cytokines level of the remission and non-remission/relapse group from ＂before＂ and ＂after＂ group respectively. Results There were 43 cases all,5 cases whose blood were taken before therapy,38 cases whose blood were taken after therapy ,34 cases were in Remission group ,9 cases were in non-remission/relapse group. ① TH1 cytokines level： Testing before therapy：non-remission/relapse group had a higher level of IFN; Testing after therapy：non-remission/relapse group had a higher level of TNF and IL-2. ② TH2 cytokines level： Testing before therapy： non-remission/relapse group had a higher level of IL-4; Testing after therapy： non-remission/relapse group had a higher level of IL-4 and IL-6. Conclusion Children ITP who hasn＇ t received therapy before testing TH cytokines has a higher level of IFN and IL-4 will has a delayed remission; while who has received first-line therapy after testing TH cytokines has a higher level of TNF,IL-2,IL-4 and IL-6 will has a bad prognosis. Therefore it is meaningful to test TH cytokine to evaluate prognosis of ITP.