气不摄血证免疫性血小板减少症患者细胞免疫功能变化及其临床意义

Immune Function Changes and Clinical Significance of Immune Thrombocytopenia Patient with Syndrome of Qi Failing to Control Blood

目的:观察气不摄血证免疫性血小板减少症(ITP)患者细胞免疫功能变化,从细胞层面探究气不摄血证ITP的生物学基础。方法:选取2016年12月至2017年5月在中国中医科学院西苑医院与北京中医药大学东方医院门诊就诊的ITP确诊患者42例,依据中医证候积分分级标准,将患者分为轻度、中度、重度3组,同时纳入26例体检健康者作为对照组,观察各组Th1、Th2、Th17、Treg、Breg细胞的表达比例变化情况,并对上述免疫细胞的表达与中医证候积分的相关性进行分析。结果:与正常对照组比较,气不摄血证ITP患者Breg与Th17细胞的表达比例下降,Th1细胞的表达比例上升(P<0.05),Th1/Th2呈Th1型(P<0.05),Treg与Th2细胞的表达以及Th17/Treg比值无统计学意义。与对照组比较,轻度组(P<0.05)、中度组(P<0.05)、重度组(P<0.05)的Breg细胞的表达显著降低,Th1细胞的表达和Th1/Th2比值显著升高,Treg、Th2以及Th17细胞的表达、Th17/Treg比值差异无统计学意义。中度组与重度组Breg细胞的表达显著低于轻度组(P<0.05),其他免疫细胞的表达与轻度组比较差异无统计学意义。重度组上述免疫细胞细胞的表达与中度组比较差异无统计学意义。Bre细胞的表达与中医证候积分具有负相关性(r=-0.488,P=0.001),其余免疫细胞无相关性。结论:气不摄血证ITP患者细胞免疫功能变化表现为Th1细胞表达增加导致Th1/Th2失衡。Th17与Breg细胞表达水平下降。Breg细胞表达水平可能反映了气不摄血证患者的气虚严重程度。

Objective： To analyze the immune function changes in patients with immune thrombocytopenia（ ITP） with syndrome of qi failing to control blood,then figure out the material basis of the syndrome of qi failing to control blood based on the expressions of immune cells. Methods： According to the traditional Chinese medicine（ TCM） syndrome score,42 patients with ITP in our hospital from December 2016 to May 2017 were separated into mild group（ MIG）,moderate group（ MOG）,and severe group（ SG）.Twenty-six healthy people were as control group（ CG）. The expressions of Th1,Th2,Th17,Treg and Breg and the relationship between the expressions of them and the TCM syndrome scores were analyzed. Results： As comparison with CG,the expressions of Breg and Th17 were lower（ P 〈 0. 05）,while the Th1,Th1/Th2 were higher（ P 〈 0. 05） in the ITP patients. The expressions of Th2,Treg and Th17/Treg in ITP patients had no significant differences with those in CG. The expressions of Breg were lower,while as the expressions of Th1 and Th1/Th2 were higher in MIG（ P 〈 0. 05）,MOG（ P 〈 0. 05）,and SG（ P 〈 0. 05） than those in CG.The expressions of Th2,Treg and Th17/Treg in the three groups had no significant differences with those in CG. As compared with MIG,all of the expressions of immune cells had no significant differences in MOG and SG,except the Breg. The expression of Breg in MOG（ P 〈 0. 05） and SG（ P 〈 0. 05） was lower than those in MIG. All the expressions of immune cells had no significant differences between in MOG and in SG. There were negative correlations between expression level of Breg and TCM syndrome scores（ r =-0. 488,F = 0. 001）. The other expressions of immune cells had no correlations with TCM syndrome scores. Conclusion： The higher level of Th1 expression leading to the imbalance of Th1/Th2 and the decreasing expressions of Th17 and Breg might be the signatures of ITP with TCM syndrome of qi failing to control blood. The level of Breg expression might indicate the level of Qi deficiency.