环孢素治疗难治性自身免疫性血液病的效果及对白细胞介素17 A、白细胞介素21水平的影响

Efficacy of Cyclosporine in Treatment of Refractory Autoimmune Hematopathy and its Effects on IL-17A and IL-21

目的:探讨环孢素治疗难治性自身免疫性血液病的效果及对白细胞介素17A(IL-17A)、白细胞介素21(IL-21)水平的影响。方法:选取2017年5月至2018年10月河北北方学院附属第一医院(以下简称“我院”)收治的难治性自身免疫性血液病患者60例(分为再生障碍性贫血组、免疫性血小板减少症组和自身免疫性溶血性贫血组三个亚组,各20例),均采用环孢素治疗,设为观察组;选取同期在我院进行体检的健康体检者60名,设为对照组。评估观察组各亚组患者的治疗效果,比较两组患者IL-17A、IL-21水平,辅助性T细胞17(Th17)所占比例及实验室检查结果。结果:观察组中,三个亚组患者的临床总有效率均较高(≥85%),组间差异均无统计学意义(P>0.05)。治疗后,观察组中各亚组患者的IL-17A、IL-21水平及Th17细胞所占比例均明显高于对照组,但明显低于本组治疗前,差异均有统计学意义(P<0.05);观察组中各亚组患者的C反应蛋白、血细胞沉降率及免疫球蛋白水平均明显低于本组治疗前,血小板计数、白细胞计数、红细胞计数及网织红细胞计数均明显高于本组治疗前,差异均有统计学意义(P<0.05),且各亚组上述指标水平与对照组的差异均有统计学意义(P<0.05)。结论:环孢素用于难治性自身免疫性血液病可取得较好的疗效,有助于贫血症状、免疫功能的改善。

OBJECTIVE: To probe into the efficacy of cyclosporine in treatment of refractory autoimmune hematopathy and its effects on interleukin-17 A(IL-17 A) and interleukin-21(IL-21). METHODS: 60 patients(which were divided into 3 subgroups: group of aplastic anemia, group of immune thrombocytopenia and group of autoimmune hemolytic anemia, with 20 cases in each subgroup) with refractory autoimmune hematopathy admitted into the First Affiliated Hospital of Hebei North University(hereinafter referred to as "our hospital") from May 2017 to Oct. 2018 were selected as observation group, which was treated with cyclosporine;another 60 healthy people who were examined in our hospital during the same period were selected as control group. The efficacy of each subgroups in observation group were evaluated, levels of IL-17 A and IL-21, proportion of helper T cells 17(Th17) and results of laboratory tests were compared between the two groups. RESULTS: In observation group, all the total effective rates of three subgroups were in a high level(≥85%), while there was no statistical significance in interblock difference(P>0.05). After treatment, the proportion of Th17, levels of IL-17 A and IL-21 in each subgroup of observation group were significantly higher than those of the control group, while significantly lower than those of before treatment, with statistically significant differences(P< 0.05);levels of C-reactive protein, blood cell sedimentation rate and immunoglobulin in each subgroup of observation group were significantly lower than those of before treatment, while the platelet count, white blood cell count, red blood cell count and reticulocyte count were significantly higher than those of before treatment, with statistically significant differences(P< 0.05), all the above indices had statistical significance in differences between three subgroups and control group(P<0.05). CONCLUSIONS: The efficacy of cyclosporine in treatment of refractory autoimmune hematopathy is remarkable, which can improve the symptoms of anemia and immune function.