原发性免疫性血小板减少症患者治疗前后T淋巴细胞亚群变化的临床意义

Clinical significance of the changes of T lymphocyte subsets before and after treatment in patients with primary immune thrombocytopenia

目的探讨原发性免疫性血小板减少症患者治疗前后T淋巴细胞亚群变化的临床意义。方法选择2016年11月～2018年1月间我院收治的50例ITP患者(ITP组),另选择同期健康体检者50例作为对照组,取研究对象空腹静脉血3～5mL,应用流式细胞仪分别检测T淋巴细胞亚群CD3^+、CD4^+、CD8^+水平,并计算CD4^+/CD8^+。结果 ITP组患者治疗前的CD3^+、CD4^+、CD4^+/CD8^+分别显著低于正常对照组,CD8^+显著高于正常对照组,差异有统计学意义(P <0.05)。治疗后,ITP组患者的CD3^+、CD4^+、CD4^+/CD8^+分别显著高于治疗前,CD8^+水平显著低于治疗前,差异有统计学意义(P <0.05),但与正常对照组组间比较,差异不显著,接近正常水平。治疗后,初诊、复诊ITP患者的后T淋巴细胞亚群各指标CD3^+、CD4^+、CD8^+及CD4^+/CD8^+水平与正常对照组组间比较,未见明显差异,差异无统计学意义(P> 0.05)。结论 ITP的发病机制较复杂,体液免疫和细胞免疫与ITP发病具有密切关系,部分患者体内同时存在着体液免疫和细胞免疫的异常,通过检测T淋巴细胞亚群相关参数,对ITP的诊断具有重要的临床价值。

Objective To investigate the clinical significance of T lymphocyte subsets changes in patients with primary immune thrombocytopenia before and after treatment. Methods Fifty ITP patients admitted to our hospital from November 2016 to January 2018 （ITP group） were selected.Another 50 cases of health examination in the same period were selected as the control group.The fasting venous blood of the subjects was taken from 3 to 5 mL.The levels of CD3＋,CD4＋ and CD8＋ in T lymphocyte subsets were detected by flow cytometry and CD4＋/CD8＋ was calculated. Results CD3＋,CD4＋,CD4＋/CD8＋ in ITP group were significantly lower than those in normal control group before treatment,and CD8＋ was significantly higher than those in normal control group （P 〈0.05）.After treatment,the levels of CD3＋,CD4＋,CD4＋/CD8＋ in ITP group were significantly higher than those before treatment,and the levels of CD8＋ were significantly lower than those before treatment （P 〈0.05）.But compared with the normal control group,the difference was not significant,close to normal level.After treatment,the levels of CD3＋,CD4＋,CD8＋ and CD4＋/CD8＋ in post-T lymphocyte subsets of newly diagnosed and re-visited ITP patients were not significantly different from those of the normal control group （P 〉0.05）. Conclusion The pathogenesis of ITP is complicated.Humoral immunity and cellular immunity are closely related to the pathogenesis of ITP.Some patients have abnormal humoral immunity and cellular immunity at the same time.It is of great clinical value to diagnose ITP by detecting relevant parameters of T lymphocyte subsets.