rhTPO对原发性免疫性血小板减少性紫癜患者T、B淋巴细胞免疫功能的影响

Effects of Recombinant Human Thrombopoietin on Funtion of T and B Lymphocyte in Prieary ITP Patients

目的:探讨ITP患者使用重组人血小板生成素(rhTPO)治疗前、后外周血Th1和Th2细胞因子及B淋巴细胞水平变化及其临床意义。方法:采用CBA技术检测48例ITP患者治疗前后及正常对照组35例外周血Th1和Th2细胞因子水平及B淋巴细胞数的变化,结果:治疗前48例ITP组外周血Th1细胞因子水平明显高于正常对照组,而Th2细胞因子明显低于正常对照组,B淋巴细胞数明显高于正常对照组,差异均具有统计学意义(P<0.05);外周血CD19+细胞和CD5+CD19+细胞数及IL-2水平与血小板数呈负相关(r=-0.75),IL-4与血小板数呈正相关(r=0.81),经rhTPO治疗后Th1细胞因子水平及外周血CD19+和CD5+CD19+细胞数均较治疗前明显下降,Th2细胞因子水平较治疗前明显上升(P<0.05);结论:ITP患者外周血Th1和Th2细胞因子异常表达及B淋巴细胞数明显升高,ITP病情严重程度与Th1和Th2细胞因子及B淋巴细胞相关。TPO治疗后血小板数上升,可能通过调节ITP患者外周血Th1和Th2免疫平衡及B淋巴细胞水平而发挥作用。

Objective:To study the changes of Th1 and Th2 type cytokines and B lymphocyte level and their clinical significance in idiopathic thrombocytopenic purpura(ITP)patients treated by recombinant human thrombopoietin(rhTPO).Methods:The peripheral blood levels of Th1 and Th2 type of cytokines and B lymphocyte were estimated by CBA in48 patients with ITP,and compared with those in 35 control persons of heath examination.Results:Before treatment,the levels of Thl type cytokines and B lymphocyte in 48 patients with ITP were higher,and the levels of Th2 type cytokines were lower than those of healthy controls(P<0.05).The levels of the peripheral blood CD19^+cells,CD5^+CD19^+cells,IL-2 expression negatively correlated with Plt counts in ITP patients(P<0.05),the levels of IL-4 positively correlated with Plt counts(P<0.05).After treatment with rhTPO,the levels of Thl type cytokines and B lymphocytes in 48 patients with ITP significantly decreased,and the levels of Th2 type cytokines significantly increased in comparison with those before treatment(P<0.05).Conclusion:Peripheral blood Thl and Th2 type cytokines express abnormally and level of B lymphocytes increases significantly in ITP patinets.The disease severity correlats with the levels of Th1 and Th2 type cytokines and B lymphocytes.Platelets increase after rhTPO treatment,showing that rhTPO can play an important role in regulating Th1 and Th2 immunologic balance and B lymphocyte level in ITP patients.