原发免疫性血小板减少症患者脾脏组织调节性T细胞和Th17细胞数量的研究

Quantity of Treg cells and Thl7 cells in spleen of primary immune thrombocytopenic purpura patients

目的观察成人原发免疫性血小板减少症（ITP）患者脾脏组织中调节性T细胞（Treg细胞）和Th17细胞的变化。方法2008年12月1日至2016年6月30日期间在福建医科大学附属协和医院接受睥切除术治疗的43例ITP患者纳入研究，男20例，女23例，中位年龄36（18～76）岁。以30例因胰腺疾病或脾外伤接受脾切除术的患者作为对照组，男21例，女9例，中位年龄47（21～69）岁。运用免疫组化技术对脾脏组织中Treg细胞和Th17细胞数量进行观察，计算Treg细胞／Th17细胞比值，分析ITP组与对照组以及脾切除有效与无效ITP患者脾脏组织中Treg、Th17细胞数量及Treg／Th17细胞比值差异。结果①ITP组脾脏组织中Treg细胞少于对照组[（11．3±4．7）个／mm^2对（59．0±15．0）个／mm^2，t=-22．894，P〈0．001]，Th17细胞多于对照组[（235．2±69．4）个／mm^2对（181．1±23．7）个／mm^2，t=13．768，P〈0．001]，Treg／Th17细胞比值低于对照组（0．048±0．027对0．328±0．086，t=19．522，P〈0．001）。②脾切除术无效ITP患者脾脏组织中Treg细胞少于有效患者[（9．5±5．0）个／mm。对（11．6±4．7）个／mm^2，t=-2．723，P=-0．010]，Th17细胞计数、Treg／Th17细胞比值差异无统计学意义[（232．3±80．8）个／mm^2对（239．6±66．9）个／mm^2，t=-1．108，P=0．277；0．040±0．024对0．053±0．027，t=-0．540，P=-0．592]。结论成人ITP患者脾脏组织中Treg、Th17细胞数量有显著改变，可能与脾切除术疗效有一定关联。

Objective To observe the quantity of Treg cells and Thl7 cells in spleen of adult primary immune thrombocytopenic purpura （ITP） patients. Methods 43 ITP cases with splenectomy treatment were enrolled from December 2008 to June 2016 at Union Hospital of Fujian Medical University, including 20 males and 23 females with a median age of 36 （18-76） years. The controls were thirty patients who underwent splenectomy because of pancreatic diseases or splenic impairment, including 21 males and 9 females with a median age of 47 （21-69 ） years. The quantity and ratio of Treg cells and Thl 7 cells were examined by immunohistochemistry between ITP patients and controls. Results ①The quantity of Treg cells in ITP were less than controls [ （ 11.3±4.7）/mm2 vs （59.0± 15.0）/mm2, t=-22.894,P〈0.001 ] ,but Th17 cells were more than controls [ （235.2±69.4）/mm2 vs （ 181.1 ±23.7）/mm2, t=-13.768, P〈0.001]. So the ratio of Treg/Th17 in ITP was lower than controls （0.048±0.027 vs 0.328±0.086, t=-19.522, P〈0.001 ）. ②The quantity of Treg ceils in cases without response after splenectomy were less than cases with response [ （9.5± 5.0）/mm2 vs （11.6±4.7）/mm2, t=-2.723, P=0.010], and there is no statistical differences between the two groups about the quantity of Thl7 cells and the ratio of Treg/Th17 cells [ （232.3±80.8）/mm2 vs （239.6± 66.9）/mm^2, t=-1.108, P=-0.277; 0.040±0.024 vs 0.053±0.027, t=0.540,P=0.592]. Conclusions There is a significant difference about the quantity of Treg cells and Thl7 cells in spleen between ITP patients and healthy controls, and they are relevant to the response after splenectomy.