儿童免疫性血小板减少症免疫细胞亚群及其相关因子的改变和临床意义

Changes of immunocyte subsets and their related factors in children with immune thrombocytopenia

目的探讨T细胞与树突状细胞（DCs）亚群及其相关因子在儿童免疫性血小板减少症（ITP）治疗前后的变化并分析其临床意义。方法采用流式细胞术检测64例ITP儿童（ITP组）治疗前后和65例正常对照儿童（对照组）外周血T细胞和DCs亚群，采用ELISA方法检测其血清IL4、IFN-γ TGF—β1和IL-27表达水平。结果ITP组采用糖皮质激素或丙种球蛋白治疗，治疗后，ITP组有效41例（有效组），无效23例（无效组）。治疗前，ITP组辅助性T细胞（Th）、Th／抑制性T细胞（Ts）、调节性T细胞（Treg）、浆细胞样DC（pDC）、pDC／髓样DC（mDC）和TGF—B1水平明显低于对照组（P〈0．05），而IFN-γ和IFN-β1／rL-4水平明显高于对照组（P〈0．05）；ITP组有效组治疗后Th、Th／Ts、Treg、pDC、pDC／mDC、TGF—β1和IL-27水平较治疗前明显升高，而IFN-γ和IFN-β1 IL-4明显降低（P〈0．05），无效组治疗前后各指标差异无统计学意义（P〉0．05）。结论ITP组患儿存在T细胞和DCs亚群紊乱及相关细胞因子水平异常；免疫抑制治疗后，有效组ITP患儿的T细胞和DCs亚群紊乱及细胞因子水平异常可得到纠正，表明Thl亢进及Treg、pDC数量及功能减低可能与儿童ITP的发病相关。

Objective To investigate the changes of T cells and dendritic cells （DCs） and their re- lated factors in children with immune thrombocytopenia （ITP） before and after therapy, and to analyze their clinical significance. Methods T-cells and DCs subsets were determined by flow cytometry both in 64 chil- dren with ITP （ITP group） before and after therapy and the control group. The serum levels of interleukin （IL）-4, interferon-γ （IFN-β1）, transforming growth factor beta 1 （TGF-β1） , and IL-27 were detected by enzyme linked immunosorbent assay （ELISA）. Results Treatments of glucocorticoid or IVIg were effective in 41 cases of 64 ITP children. Compared to the control group, helper T cells （Th） , Th/suppressor T cells （Ts）, T regulatory cells （Treg）, plasmaeytoid DC （pDC）, pDC/myeloid DC （mDC）, and TGF-β1 in ITP patient group before treatment were significantly lower, while IFN-γ and IFN-γ/IL-4 were significantly higher （P 〈 0. 05）. In ITP group, Th, Th/Ts, Treg, pDC, pDC/mDC, TGF-β1, and IL-27 were signifi- cantly increased, while IFN-γ and IFN-γ/IL-4 were decreased in children with ITP after therapy and a- chieved response （ P 〈 0. 05 ）. However, there was no significant difference between before and after thera- py in ITP children without treatment response （P 〉 0. 05 ）. Conclusions T cells and DCs subsets disorder and abnormal cytokine levels are observed in children with ITP, which can be corrected by iminunosuppres- sive therapy, indicating that Thl overactivity and the decrease of Treg and pDC both in quantity and functionmay be related to the pathogenesis of ITP in children.