45例原发免疫性血小板减少症患者IL-23／IL-17轴表达的研究

Abnormal expression of IL-23/IL-17 axis in peripheral blood of 45 patients with primary immune thrombocytopenia

目的研究IL-23／IL-17轴各亚基、受体基因及蛋白在原发免疫性血小板减少症（ITP）患者外周血中的表达及意义。方法采用实时荧光定量逆转录．聚合酶链反应（R1-PCR）技术检测45例初诊ITP患者及30例健康对照外周血单个核细胞（PBMC）IL-23p19、p40、IL-12p35，受体IL-23R、IL-12Rβ1、IL-12Rβ2，IL-17A、IL-17F基因表达量，用ELISA方法检测IL-23、IL-17的蛋白表达，分析ITP患者IL-23、IL-17表达与PLT的相关性。结果（1）WP患者外周血PBMCIL-23p19、p40，受体IL-23R、IL-12Rβ1，IL-17A、IL-17F相对表达量分别是健康对照组的5．58、2．13、4．20、2．45、4．29、2．50倍。（2）ITP组外周血清IL-23蛋白表达高于健康对照组[（198．70±94．56）ng／L对（50．72±22．97）ng／L，t=-10．06，P〈0．001]，血清IL—17表达高于健康对照组[（85．25±21．97）ng／L对（11．39±4．27）ng／L，t=21．94，P〈0．001]。（3）ITP患者外周血中IL．23表达与PLT呈负相关（r=0．408，P〈0．01），IL-17的表达与PLT呈负相关（r=0．464，P〈0．01），IL．23与IL-17的表达呈正相关（r=0．496，P〈0．01）。结论IL-23／IL-17轴基因及蛋白在ITP中表达异常，提示IL-23／IL-17轴在ITP发病中有一定作用。

Objective To investigate the expression of IL-23/IL-17 axis in peripheral blood of patients with primary immune thrombocytopenia （ITP） and its clinical significance. Methods The real-time quantitative reverse transcription-polymerase chain reaction （RT-PCR） was used to determine the expression of IL- 23 p 19, p40, p35, IL- 23 R, IL- 12R~ 1, IL- 12Rβ2, IL- 17 A, IL- 17F mRNA in the peripheral blood of 45 ITP patients and 30 healthy controls. The correlations between the expression of IL-23 and IL-17, platelet counts, serum cytokine concentrations of ITP patients were analyzed. Furthermore, nine newly diagnosed ITP patients were followed up during treatment. Results The gene expressions of IL-23pl 9, p40, IL-23R, 1L-12Rβ1, IL-17A, IL-17F in ITP patients were significantly higher than those in healthy controls, the relative expression levels of ITP were 5.58, 2.13, 4.20, 2.45, 4.29, 2.50 times as much as that of healthy controls. And elevated serum IL-23 [ （198.70±94.56） ng/L vs （50.72±22.97） ng/L, t= 10.06, P〈0.001 ], IL- 17 [ （85.25±21.97） ng/L vs （11.39±4.27） ng/L, t=21.94, P〈0.001 ] levels were also observed in these ITP patients. In addition, the serum IL-23 level in ITP patients was positively correlated with IL-17 （r=0.496, P〈0.01 ）, but negatively correlated with the platelet counts （r=-0.408, P〈0.01 ）, and IL-17 level was negatively correlated with platelet counts（r=-0.464, P〈0.01 ）. Conclusion The IL-23/IL- 17 expression in ITP patients was significantly elevated, indicating IL-23/IL-17 play an important role in the pathogenesis of ITR [Key words] Thrombocytopenia; Interleukins; Pathogenesis