不同剂量丙种球蛋白对急性免疫性血小板减少症患儿血清白细胞介素-6和白细胞介素-10及自然杀伤细胞表达的影响

Influences of different doses of intravenous immunoglobulin on the expressions of interleukin-6,interleukin-10and natural killer cells in children with acute immune thrombocytopenia

目的探讨急性免疫性血小板减少症(immune thrombocytopenia,ITP)患儿应用不同剂量丙种球蛋白(intravenous immunoglobulin,IVIG)治疗前、后血清白细胞介素(interleukin,IL)-6、IL-10水平及自然杀伤(natural killer,NK)细胞占外周血单个核细胞百分比(NK细胞比率)变化。方法新确诊急性ITP患儿50例,随机分为低剂量组和高剂量组各25例,同期健康儿童25例为对照组。低剂量组静脉滴注IVIG 0.4g/(kg·d),高剂量组静脉滴注IVIG 1.0g/(kg·d),均连续2d;之后均口服泼尼松1.5~2.0mg/(kg·d),血小板计数≥100×10^9/L后稳定1周,逐渐减量至停药。分别于IVIG治疗前、后测定血清IL-6、IL-10水平,NK细胞计数及NK细胞比率,并与对照组进行比较。结果急性ITP患儿治疗前血清IL-6[(7.72±6.37)ng/L]、IL-10[(6.01±3.67)ng/L]高于对照组[(3.63±2.55)、(4.28±1.97)ng/L](P<0.05),NK细胞比率[(9.06±3.99)%]低于对照组[(11.61±5.23)%](P<0.05),NK细胞计数[(571.31±394.35)个/μL]与对照组[(602.97±497.27)个/μL]比较差异无统计学意义(P>0.05)。IVIG治疗前,低、高剂量组血清IL-6[(7.18±6.04)、(11.85±2.12)ng/L]、IL-10[(5.39±3.15)、(6.64±4.09)μg/L]、NK细胞计数[(544.20±340.42)、(598.59±447.29)个/μL]及NK细胞比率[(9.11±3.73)%、(9.01±4.30)%]比较差异无统计学意义(P>0.05)。IVIG治疗后,低、高剂量组血清IL-6水平[(8.76±5.12)、(16.35±6.87)ng/L]均高于治疗前(P<0.05),IL-10水平[(4.75±2.50)、(5.22±3.90)ng/L]、NK细胞比率[(6.90±4.13)%、(8.31±5.52)%]、NK细胞计数[(340.39±471.55)、(374.24±268.27)个/μL]较治疗前下降(P<0.05),高剂量组治疗后IL-6水平高于低剂量组(P<0.05),IL-10、NK细胞计数及NK细胞比率与低剂量组比较差异无统计学意义(P>0.05)。结论低、高剂量IVIG均可上调ITP患儿血清IL-6水平,降低IL-10、NK细胞计数、NK细胞比率。

Objective To investigate the changes of serum levels of interleukin(IL)-6,IL-10and the proportion of natural killer(NK)cells in peripheral blood mononuclear cells before and after treatment with different doses of intravenous immunoglobulin(IVIG)in children with acute immune thrombocytopenia(ITP).Methods Fifty children with newly diagnosed ITP were randomly and equally divided into low-dose IVIG group and high-dose IVIG group,while another 24healthy children were as controls(control group).Low-dose IVIG group received intravenous injection of 0.4g/(kg·d)IVIG and high-dose IVIG group received 1.0g/(kg·d)IVIG for 2consecutive days,followed by oral administration of 1.5to 2.0mg/(kg·d)prednison,and the dose was gradually reduced and terminated one week after the platelet count was≥100×10^9/L.The serum IL-6and IL-10levels,the count of NK cells and the proportion of NK cells were detected before and after IVIG treatment,and compared with control group.Results The levels of IL-6and IL-10were higher in children with acute ITP((7.72±6.37),(6.01±3.67)ng/L)than those in control group((3.63±2.55),(4.28±1.97)ng/L)before treatment(P<0.05),the proportion of NK cells was lower in children with acute ITP((9.06±3.99)%)than that in control group((11.61±5.23)%)(P<0.05),and the count of NK cells showed no significant difference between children with acute ITP((571.31±394.35)cells/μL)and control group((602.97±497.27)cells/μL)(P>0.05).The levels of IL-6((7.18±6.04),(11.85±2.12)ng/L),the levels of IL-10((5.39±3.15),(6.64±4.09)ng/L),the counts of NK cells((544.20±340.42),(598.59±447.29)cells/μL)and the proportions of NK cells((9.11±3.73)%,(9.01±4.30)%)showed no significant differences between low-and highdose IVIG groups before treatment(P>0.05).The levels of IL-6were higher in low-and high-dose IVIG groups after treatment((8.76±5.12),(16.35±6.87)ng/L)than those before treatment(P<0.05),while the levels of IL-10((4.75±2.50),(5.22±3.90)ng/L),the proportions of NK cells((6.90±4.13)%,(8.31±5.52)%),and the counts of NK cells((340.39±471.55),(374.24±268.27)cells/μL)were lower after treatment than those before treatment(P<0.05).The level of IL-6was higher in high-dose group than that in low-dose group after treatment(P<0.05),while the IL-10level,the count of NK cells and the proportion of NK cells showed no significant differences between two groups(P>0.05).Conclusion Both low and high doses of IVIG can up-regulate the level of IL-6,and down-regulate the level of IL-10,the proportion of NK cells and the count of NK cells.