原发性免疫性血小板减少症患者脾切除术前T淋巴细胞亚群检测的临床意义

Clinical significance of measurement of T lymphocyte subsets before splenectomy in patients with primary immune thrombocytopenia

目的分析激素治疗无效或停药后复发的原发性免疫性血小板减少症(ITP)患者脾切除术前T淋巴细胞亚群、自然杀伤细胞的变化,探讨其与脾切除后ITP早期复发的关系。方法收集2009年1月-2015年12月于深圳市宝安区人民医院治疗的ITP脾切除患者32例,随访时间3~60个月,按脾切除疗效分为早期复发组(脾切除后6个月内复发,PLT<30×109/L)及有效组(脾切除后PLT>30×109/L且较切除前PLT增加2倍以上)。应用流式细胞技术检测患者脾切除术前外周血T淋巴细胞亚群(CD3+CD4+、CD3+CD8+、CD3+CD4+/CD3+CD8+、CD3-CD19+)及CD56+CD16+自然杀伤细胞的百分比(CD3-/CD16+CD56+)。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验或Fisher检验。结果早期复发组患者11例(占34.4%),有效组21例(占65.6%)。早期复发组脾切除术前CD3+CD4+、CD3+CD4+/CD3+CD8+明显低于有效组[(21.7±5.4)%vs(32.6±4.1)%,t=6.39,P=0.015;0.65±0.21 vs 1.29±0.36,t=3.92,P=0.003];早期复发组脾切除术前CD3+CD8+明显高于有效组[(34.5±5.9)%vs(26.8±6.6)%,t=-3.20,P=0.030];两组患者CD3-/CD16+CD56+、CD3-CD19+差异均无统计学意义(P值均>0.05)。结论行脾切除术治疗前CD3+CD4+、CD3+CD4+/CD3+CD8+低的ITP患者,术后易出现复发,提示T淋巴细胞亚群异常可作为ITP脾切除疗效预测的参考指标之一。

Objective To investigate the changes in lymphocyte subsets and natural killer （NK）cells before splenectomy in patients with primary immune thrombocytopenia （ITP）who have no response to corticosteroid therapy or experience recurrence after drug withdrawal,as well as their association with early ITP recurrence after splenectomy.Methods A total of 32 patients with ITP who were treated with sple-nectomy in The People′s Hospital of Bao′an District from January 2009 to December 2015 and followed up for 3 -60 months were enrolled and divided into early recurrence group （with recurrence within 6 months after splenectomy and platelet count 〈30 ×109 /L）and response group （platelet count 〉30 ×109 /L after splenectomy,two -fold increase compared with before splenectomy）according to the outcome of splenectomy.Flow cytometry was used to measure the percentages of peripheral blood lymphocyte subsets （CD3 ＋CD4 ＋,CD3 ＋CD8 ＋, CD3 ＋CD4 ＋/CD3 ＋CD8 ＋,and CD3 -CD19 ＋）and CD56 ＋CD16 ＋ NK cells before splenectomy.The t -test was used for comparison of continuous data between groups and the chi -square test or Fisher′s exact test was used for comparison of categorical data between groups. Results There were 11 patients （11 /32,34.4%）in the early recurrence group and 21 （21 /32,65.6%）in the response group.Com-pared with the response group,the early recurrence group had a significantly lower percentage of CD3 ＋CD4 ＋（21.7% ±5.4% vs 32.6% ± 4.1%,t =6.39,P =0.015）and a significantly lower CD3 ＋CD4 ＋/CD3 ＋CD8 ＋ ratio （0.65 ±0.21 vs 1.29 ±0.36,t =3.92,P =0.003）,as well as a significantly higher percentage of〗CD3 ＋CD8 ＋T cells （34.5% ±5.9% vs 26.8% ±6.6%,t =-3.20,P =0.030） before splenectomy.There were no significant differences in CD3 -/CD16 ＋CD56 ＋ ratio and the percentage of CD3 -CD19 ＋ T cells be-tween the two groups （both P 〉0.05）.Conclusion ITP patients with a low percentage of CD3 ＋CD4 ＋ T cells and a low CD3 ＋CD4 ＋/CD3 ＋CD8 ＋ ratio before splenectomy tend to experience recurrence after surgery,which suggests that abnormal T lymphocyte subsets can be used as one of the reference indices for predicting the clinical outcome of splenectomy in ITP patients.