特发性血小板减少性紫癜患儿细胞免疫功能变化及临床意义

Changes of Cellular Immune Function in Children with Idiopathic Thrombocytopenic Purpura and Its Clinical Significance

目的探讨特发性血小板减少性紫癜(ITP)患儿细胞免疫功能的变化及其临床意义。方法将2013年8月~2015年7月在笔者医院儿科住院的83例ITP初治患儿及31例同期在笔者医院门诊体检的健康同龄儿纳入研究,采用流式细胞术检测外周血T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8比例,采用酶联免疫吸附试验检测血浆细胞因子IFN-γ及IL-4浓度。结果治疗前病例组CD3 60.07%±11.85%、CD4 34.18%±11.72%、CD4/CD8 1.76%±0.94%及IL-4 11.24±8.42pg/ml水平显著低于对照组70.96%±7.26%、45.05%±6.53%,2.26%±0.66%及21.26±9.34pg/ml,IFN-γ水平5.88±4.02pg/ml显著高于对照组2.12±1.09pg/ml;治疗后8周后,CD3 65.76%±10.87%、CD4 38.71%±11.81%及IL-4 14.59±11.59pg/ml水平均较治疗前升高,IFN-γ3.65±3.15pg/ml水平均较治疗前降低,差异有统计学意义(P<0.01或P<0.05)。结论 ITP患儿存在细胞免疫功能紊乱,Th1/Th2平衡失调可能与ITP的发病机制和疾病的活动状态密切相关。

Objective To investigation the changes of cellular immune function in children with idiopathic thrombocytopenic purpura（ITP） and its clinical significance. Methods Eighty-three children with ITP hospitalized in our hospital from August 2013 to July 2015 and 31 healthy children as control group were enrolled in this study. The proportion of T lymphocyte CD3, CD4, CD8, CD4/CD8 in peripheral blood of the patients and healthy subsets were analyzed by flow cytometry. The plasma concentrations of cytokines IFN-γ and IL-4 were detected by ELISA. Results ① Compared with the control group, the levels of CD3 60.07%11.85%,CD4 34.18%11.72%,CD4/CD8 1.76%0.94% and IL-4 11.248.42pg/ml were significantly lower and IFN-γ 5.884.02pg/ml was significantly higher in the case group before treatment. ② After 8 weeks of treatment, the levels of CD3 65.76%10.87%, CD4 38.71%11.81% and IL-4 14.5911.59pg/ml were significantly increased and IFN-γ 3.653.15pg/ml was significantly decreased than before（P 〈 0.01 or P 〈 0.05）. Conclusion There is a disorder of cellular immune function in children with ITP, and the imbalance of Thl/Th2 may be closely related to the pathogenesis of ITP and the active state of the disease.