儿童免疫性血小板减少症患者外周血B淋巴细胞亚群变化的研究

B Lymphocyte Subsets in Peripheral Blood of Patients with Pediatric Immune Thrombocytopenia

目的探讨儿童免疫性血小板减少症患者(immune thrombocytopenia,ITP)外周血中CD38,CD27,CD19表达阳性的B淋巴细胞亚群的变化及临床意义。方法选取2017年1月～12月中山大学孙逸仙纪念医院收治的初诊ITP患儿21例为初诊未治疗组(untreated ITP,U-ITP),完全缓解ITP患儿30例为完全缓解组(remission ITP,R-ITP)及同期健康体检儿童26例为健康对照组(normal control,NC),运用流式细胞术对其外周血B淋巴细胞亚群进行检测并与ITP患儿的PLT计数进行相关性分析。结果外周血总CD19^+B淋巴细胞比例:U-ITP组显著高于R-ITP组和NC组(F=7.543,P<0.01)。外周血CD19^+CD27^+CD38-记忆性B细胞占CD19^+B细胞百分率:U-ITP组显著高于R-ITP组和NC组(F=8.876,P<0.001)。CD19^+CD27-CD38-初始B细胞占CD19^+B细胞百分率:U-ITP组显著低于R-ITP组)和NC组(F=5.058,P<0.01)。CD19^+CD27^+CD38^+浆母细胞百分率:U-ITP组显著高于R-ITP组和NC组(F=9.588,P<0.001),而R-ITP组与NC组比较,B淋巴细胞各分群差异均无统计学意义(F=0.842～1.258,均P>0.05)。PLT计数与总CD19^+B细胞百分率呈负相关(r=-0.318,P=0.007),与CD19^+CD27^+CD38-记忆性B细胞百分率呈负相关(r=-0.444,P=0.000),与CD19^+CD27-CD38-初始B细胞百分率呈正相关(r=0.416,P=0.000),与CD19^+CD27^+CD38^+浆母细胞百分率呈负相关(r=-0.442,P=0.000)。结论 B淋巴细胞亚群在ITP患儿体内分布存在异常,其检测能够为ITP患儿临床疾病监测与判断预后提供重要的指导作用。

Objective To investigate the change and clinical significance of B lymphocyte subsets marked by CD38,CD27 and CD19 in peripheral blood of pediatric patients with immune thrombocytopenia. Methods A total of 51 ITP patients（21 patients were newly diagnosed and untreated, 30 patients were in remission）were collected from January 2017 to December 2017 in Sun Yat-Sen Memorial Hospital,and 26 normal controls were enrolled in this study. The abnormal of B lymphocyte subsets in peripheral blood of research cohort were detected by flow cytometry and their correlations with platelet count were analyzed. Results The percentage of total CD19 B cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls （F= 7. 543, P〈0.01）. The percentage of memory B cells in CD19 B cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls （F =8. 876, P〈 0. 001）. The percentage of naive B cells in CD19 1B cells of untreated ITP patients was significantly lower than that of remission ITP patients and normal controls （F =5. 058, P〈0.01）. The percentage of plasmablasts cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls （F= 9. 588, P〈0. 001）. There was no significant difference in B lymphocyte subsets between remission ITP patients and the normal controls （F =0. 842- 1. 258, all P〉0.05）. The PLT count had significantly negative correlation with the percentage of total CD19 1 B cells （r =0. 318, P = 0. 007）, memory B cells （r= 0. 444, P= 0. 000）, plasmablasts cells （r= 0. 442, P= 0. 000） and had significantly positive correlation with naive B cells （r=0. 416, P =0. 000）. Conclusion The distribution of B lymphocyte subsets was abnormal in ITP patients. The detection of B lymphocyte subsets can be used as a useful indicator of clinical disease surveillance and prognosis in ITP patients.