T淋巴细胞相关细胞因子与儿童慢性免疫性血小板减少症转归的相关性研究

Correlation study between T lymphocyte-related cytokines and the outcome of chronic immune thrombocytopenia in children

目的检测儿童慢性免疫性血小板减少症(ITP)外周血各细胞因子水平,分析其在儿童慢性ITP临床预后中的意义。方法随访并选取2015年10月至2018年10月在新乡医学院第一附属医院儿内科治疗的慢性ITP患儿30例作为试验组,同期选取本院健康体检儿童40例作为健康对照组。采用流式微球阵列技术(CBA)动态检测试验组治疗前、治疗后12个月及健康对照组白细胞介素-2(IL-2)、γ-干扰素(IFN-γ)、肿瘤坏死因子(TNF)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-17A(IL-17A)水平,分析其与儿童慢性ITP预后的关系。结果试验组共纳入30例慢性ITP患儿,试验组治疗前IL-2、IL-17A水平分别为(7.86±3.90)ng/L、(10.45±12.35)ng/L,健康对照组IL-2、IL-17A水平分别为(3.11±2.41)ng/L、(2.97±7.04)ng/L,试验组显著高于健康对照组(t=-7.123、-5.582,均P<0.01)。试验组治疗前IL-4、IL-10水平分别为(0.38±0.25)ng/L、(1.80±1.25)ng/L,健康对照组IL-4、IL-10水平分别为(3.08±0.26)ng/L、(4.55±3.44)ng/L,试验组显著低于健康对照组(t=8.400、5.653,均P<0.01)。试验组治疗前IL-6、TNF、IFN-γ水平分别为(7.30±9.16)ng/L、(4.85±7.60)ng/L、(7.68±20.41)ng/L,健康对照组IL-6、TNF、IFN-γ水平分别为(5.44±4.18)ng/L、(1.97±0.37)ng/L、(4.81±17.71)ng/L,2组比较差异均无统计学意义(均P>0.05);试验组治疗前与治疗后12个月细胞因子水平比较差异无统计学意义(P>0.05)。结论T淋巴细胞相关细胞因子变化与儿童慢性ITP的发病及疾病发展密切相关,慢性ITP患儿可能持续存在免疫功能紊乱,而动态检测细胞因子IL-2、IL-4、IL-10、IL-17A,特别是IL-17A,有助于判断儿童ITP的转归,可能对评估临床预后有指导意义。

Objective To detect the levels of cytokines in peripheral blood of patients with chronic immune thrombocytopenia(ITP)and analyze their significance in the clinical prognosis of children with chronic ITP.Methods Thirty patients with chronic ITP who were treated in the Department of Pediatrics,the First Affiliated Hospital of Xinxiang Medical Univercity from October 2015 to October 2018 were followed and enrolled in the experimental group and 40 healthy children in the same hospital were enrolled in the healthy control group.The levels of interleukin-2(IL-2),interferon-γ(IFN-γ),tumor necrosis factor(TNF),interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10)and interleukin-17A(IL-17A)in the experimental group and the healthy control group were detected by flow cytometry(CBA).The relationship between cytokines and prognosis of children with chronic ITP were analyzed.Results Thirty patients with ITP were enrolled.The expressions of IL-2 and IL-17A in the experimental group before treatment were(7.86±3.90)ng/L and(10.45±12.35)ng/L,while those of IL-2 and IL-17A in the healthy control group were(3.11±2.41)ng/L and(2.97±7.04)ng/L.The levels of IL-2 and IL-17A in the experimental group were significantly higher than those in the healthy control group,and the differences were statistically significant(t=-7.123,-5.582,all P<0.01).The expressions of IL-4 and IL-10 in the experimental group before treatment were(0.38±0.25)ng/L and(1.80±1.25)ng/L,while those of IL-4 and IL-10 in the healthy control group were(3.08±0.26)ng/L and(4.55±3.44)ng/L.The levels of IL-4 and IL-10 in the experimental group were significantly lower than those in the healthy control group,and the differences were statistically significant(t=8.400,5.653,all P<0.01).The expressions of IL-6,TNF and IFN-γin the experimental group before treatment were(7.30±9.16)ng/L,(4.85±7.60)ng/L and(7.68±20.41)ng/L,while those of IL-6,TNF and IFN-γin the healthy control group were(5.44±4.18)ng/L,(1.97±0.37)ng/L,(4.81±17.71)ng/L.There was no significant difference between the two groups(P>0.05),and no significant difference in the levels of cytokines between the patients with chronic ITP before and 12 months after treatment(P>0.05).Conclusions The changes of T lymphocyte related cytokines are closely related to the pathogenesis and development of chronic ITP in children.There may be persistent immune dysfunction in children with chronic ITP.Dynamic monitoring of cytokines IL-2,IL-4,IL-10,IL-17A,especially IL-17A,is helpful to judge the prognosis of ITP in children,and may be of guiding significance in evaluating clinical prognosis.