妊娠合并原发免疫性血小板减少症患者的临床特点分析及T细胞分泌细胞因子水平的研究

Clinical features and levels of cytokines produced by T-cells in pregnancies with primary immune thrombocytopenia

目的 :研究妊娠合并原发免疫性血小板减少症(immune thrombocytopenia,ITP)(原发ITP,以下简称为ITP)患者的临床特点及围产期结局,同时研究T细胞分泌细胞因子水平的变化与发病间的关系。方法 :回顾性总结25例妊娠合并ITP患者、8例非妊娠的ITP患者及11例正常孕妇的临床资料,利用蛋白芯片技术检测其T细胞分泌的代表性细胞因子表达水平,并分析妊娠合并ITP患者的T细胞功能变化与其妊娠合并ITP发病间的关系。结果:13例患者(13/25)为妊娠前即有ITP病史,另12例(12/25)则于妊娠期间诊断为ITP;25例患者中的16例(64%)接受了ITP治疗,共分娩了24名新生儿,1例死胎,母亲血小板计数与新生儿间的血小板计数无相关性;蛋白芯片检测结果显示,妊娠合并ITP患者与正常孕妇相比,其肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、白细胞介素2(interleukin 2,IL-2)、IL-5、IL-6水平显著升高,IL-12p40和IL-16显著降低;同时,妊娠合并ITP患者与非妊娠期ITP患者相比,其IL-1α、IL-10及IL-13水平显著降低。结论:多数ITP孕妇母婴结局良好。T细胞分泌细胞因子水平的变化可能通过T细胞功能变化参与了妊娠合并ITP患者的发病机制,其中Th1细胞、Th17细胞及CD8+T细胞分泌的相关细胞因子水平升高可能是妊娠合并ITP患者的发病机制之一。

Objective To analyze the clinical features and perinatal outcome of pregnancies with primary immune thrombocytopenia（ITP）, and investigate the correlation of cytokines of T cell subtypes with pathogenesis of ITP. Methods Twenty-five pregnancies with ITP deliveryed at our hospital were enrolled,and 8 non-pregnant women with ITP and 11 normal pregnant women were served as controls. The course of disease and maternal and fetal outcome in these pregnancies were studied. Representative cytokines of the T cell were investigated by cytokine antibody arrays. Results Thirteen of the 25 ITP pregnancies had a diagnosis of ITP before pregnancy,and the other were diagnosed as ITP during pregnancy. In all, 16 cases received therapy. Twenty-five pregnancies delivered 24 infants ,1 had fetal distress. There was no correlation between maternal platelet count at delivery and infant platelet count at birth. The serum levels of TNF-α, IL-2,IL-5 and IL-6 were significantly higher in pregnancies with ITP than in normal pregnancies, while the levels of IL- 12p40 and IL-16 were lower. The serum levels of IL-1α, IL-10 and IL-13 were significantly lower in pregnancies with ITP than in non-pregnant ITP controls. Conclusions Most of pregnancies with ITP have good perinatal outcome.The increased levels of cytokines secreted by Thl, Th17 and CD8^＋ T cells denote a putative role in the pathogenesis of pregnancies with ITP.