CITP患者外周血Breg与CD4＋T细胞的相关性及临床意义

Correlation of Breg with CD4^+T Cells of Peripheral Blood in Patients with CITP and Its Clinical Significance

本研究检测慢性特发性血小板减少性紫癜(CITP)患者治疗前后外周血Breg亚群与CD4+T细胞数量、相关细胞因子的变化及其相关性,探讨它们在CITP发病机制中的作用。选择35例CITP患者,分离外周血单个核细胞(PBMNC),采用流式细胞术检测糖皮质激素治疗前后外周血Th1、Th17、Th22以及Breg细胞亚群的比例变化;运用ELISA法检测治疗前后PBMNC培养液上清中IFN-γ、IL-17、IL-22以及IL-10水平,与同期选择的健康对照组比较。结果表明,CITP患者治疗前外周血中Th1、Th17、Th22细胞亚群的比例均升高(P<0.05),调节性B细胞(Breg)的比例降低,差别均有统计学意义(P<0.05),而治疗后与正常对照组比较,差别均无统计学意义(P>0.05);CITP患者治疗前PBMNC培养液上清中细胞因子IFN-γ、IL-17、IL-22水平升高,IL-10的水平低于健康对照组,差别均有统计学意义(P<0.05),而治疗后与正常对照组比较,差别均无统计学意义(P>0.05)。患者Breg细胞的比例变化与培养液上清中细胞因子IL-10表达水平呈正相关(r=0.719,P<0.05),Breg细胞与Th1、Th17、Th22细胞亚群的变化呈负相关性,IL-10水平与IFN-γ、IL-17、IL-22水平也呈负相关性。结论:调节性B细胞比例及IL-10的水平下调可能参与CITP患者的CD4+T细胞免疫调节紊乱机制,可为其临床免疫调节治疗提供新的靶点与新思路。

This study was aimed to detect the level of the peripheral blood Breg and CD4＋ T cell subgroups in patients with chronic idiopathic thrombocytopenic purpura （CITP） before and after therapy, and to analyse the charge of related cytokines and their correlation, to explore their roles in the pathogenesis of CITP. A total of 35 CITP cases were taken as the research group and 35 healthy persons were served as the control group. The peripheral blood mononuclear cells （PBMNC） were separated, the percentages of Th1, Th17, Th22 and Breg cells were detected by flow cytometry before and after treatment of glucocorticoid, and the IFN-γ, IL-17, IL-22 and IL-10 levels from PBMNC culture supematant also were determined by ELISA. The results showed that there was significant difference as compared with the healthy controls, the proportion of peripheral blood Th1, Th17, Th22 cell subgroups all increased in CITe patients before treatment with glucocorticoid, the regulatory B ceils （Breg） ratio was reduced, the differences had statistical significance （P 〈 0.05 ）, but the differences were no statistically significant after treatment with glucocorticoid （P 〉 0.05）. The levels of IFN-γ, IL-17, IL-22 from culture supematant all increased in CITP patients before treatment, the level of IL-10 was lower than that of the healthy control, the difference was statistically significant （P 〈0.05）, but the there were no statistically significant differences after treatment（ P 〉 0.05 ）. There were positive correlation between theBreg cells and IL-10 expression in CITP patients （ P 〈 0.05 ）, the Breg cells and Thl, Th17, Th22 cells showed a negative correlation, IL-10 and IFN-γ, IL-17, IL-22 levels also showed a negative correlation. It is concluded that the down-regulation of regulatory B cells proportion and the IL-10 level may participate in the mechanism of CD4＋ T cell immunity disorder in CITP, which can provide new targets and ideas for the clinical immune regulation therapy.