儿童重型再生障碍性贫血Th1/Th2细胞相关因子表达研究

The expression of Th1/Th2 cells related cytokines in peripheral blood of children with severe aplastic anemia

目的利用流式细胞术探讨儿童重型再生障碍性贫血(简称"再障")患儿体内Th1和Th2细胞相关因子白细胞介素-2(IL-2)、白细胞介素4(IL-4)、白细胞介素-10(IL-10)和干扰素-γ(IFN-γ)的变化特点。方法 2014年11月至2015年8月,在郑州大学第一附属医院诊治的30例初诊重型再障患儿,同时选择正常体检儿童20名为对照组,采取其静脉血,分别用流式细胞术测定所取血样标本中IL-2、IL-4、IL-10和IFN-γ的含量。并用独立样本t检验的统计分析方法分析两组儿重外周血中上述4种细胞因子的差异是否有统计学意义,用ROC曲线评价上述4种细胞因子对于诊断重型再障的临床意义。结果(1)重型再障患儿外周血中IL-2、IFN-γ浓度分别为7.56±5.93(pg/mL)、8.67±3.72(pg/mL),均高于对照组的4.45±2.94(pg/mL)、4.89±2.86(pg/mL),差异具有显著性(P<0.05);IL-4、IL-10浓度分别为4.48±3.28(pg/mL)、9.00±3.60(pg/mL).均低于对照组的7.36±7.02(pg/mL)、10.93±5.13(pg/mL),但差异无显著性(P>0.05)。(2)重型再障患儿外周血中IL-2 ROC曲线下面积(AUC)为0.746(95%CI 0.697~0.816),具有中度诊断价值;IL-4的AUC为0.662(95%CI 0.597~0.716),为低诊断价值;IL-10的AUC为0.616(95%CI 0.458~0.774),为低诊断价值;IFN-γ的AUC为0.817(95%CI 0.697~0.978),具中度诊断价值。结论 IL-2、IFN-γ为负调控造血因子,参与再障发病机制,但是Th1和Th2细胞相关因子(IL-2、IFN-γ和IL-4、IL-10)的表达水平高低,对于儿童获得性再障的诊断价值比较有限,

Objective To investigate expression of cytokine interleukin-2 （IL-2）, interleukin-4 （IL-4）, interleukin-10 （IL-10） and interferon-γ （IFN-γ） in children with severe aplastic anemia （SAA） by flow cytometry. Methods From November 2014 to August 2015, 30 cases of newly diagnosed children with SAA was selected as experimental group treated in the First Affiliated Hospital of Zhengzhou University, and 20 children for normal physical examination as the control group. The blood samples of both groups were taken to test the level of IL-2, IL-4, IL-10 and IFN-γ by flow cytometry. In addition, independent sample t test was utilized to analysis the differences of four cytokines mentioned above in the peripheral blood of these two group. The ROC curve was used to evaluate clinical significance of above four kinds of cytokines for diagnosis of SAA. Results （1）The concentrations of IL-2and IFN-γ in peripheral blood of children with SAA were 7.56 ± 5.93 （pg/mL）, 8.67 ± 3.72 （pg/mL）, which were higher than 4.45 ± 2.94 （ pg/mL）, 4. 89 ± 2.86 （pg/mL） in the control group, and the difference was statistically significant （P 〈0.05） ; IL-4, IL 10-concentrations were 4.48 ±3.28 （ pg/mL）, 9.00 ±3.60（pg/mL）, which were lower than the control group 7.36 ±7.02（pg/mL）, 10. 93 ±5.13（pg/mL）, but the difference was not statistically significant （P 〉 0.05 ）. （2）The area under the ROC curve （AUC） of IL-2 of children with SAA was 0. 746 （95% CI 0. 697 -0. 816）, with a moderate value for diagnosis; IL-4 in the AUC was 0. 662 （95% CI 0. 597 -0. 716）, with a low diagnostic value; AUC of IL-10 was 0.616 （95% CI 0. 458 - 0. 774） , with a low diagnostic value; IFN-γ in the AUC was 0. 817 （95% CI 0. 697 -0. 978）, with moderate diagnostic value. Conclusions IL-2 and IFN-γ are negative regulators of hematopoietic, which maybe involved in the pathogenesis of aplastic anemia; but the expression of Th1 and Th2 cytokine （IL-2, IFN-γ, IL-4, IL-10） was limited for diagnosis of children with acquired aplastic anemia.