不同剂量人免疫球蛋白联合糖皮质激素治疗免疫性血小板减少症对患儿外周血Th17细胞水平的影响

Influence of High-Dose Immunoglobulin Combined With Glucocorticoids on Peripheral blood Th17 Cell Levels in Children With Immune Thrombocytopenia

目的探讨不同剂量人免疫球蛋白联合糖皮质激素治疗免疫性血小板减少症(ITP)对患儿外周血辅助性T细胞17(Th17)细胞水平的影响。方法选取78例ITP患儿,根据不同治疗剂量分为中等剂量组(中等剂量免疫球蛋白和糖皮质激素治疗,n=38)和大剂量组(大剂量免疫球蛋白联合糖皮质激素治疗,n=40),比较两组临床疗效,观察治疗前后两组Th17、调节性T细胞(Treg)水平变化,并计算Th17/Treg比值,比较两组药物安全性。结果大剂量组总有效率明显高于中等剂量组(P<0.05)。与同组治疗前比较,治疗后两组Th17、Th17/Treg明显降低,而Treg明显增高,但治疗后大剂量组Th17、Th17/Treg明显低于中等剂量组,而Treg明显高于中等剂量组(P<0.05)。两组不良反应总发生率[17.50%vs.10.53%]比较,差异无统计学意义(χ^(2)=0.782,P>0.05)。结论大剂量免疫球蛋白联合糖皮质激素治疗ITP的临床效果显著,可有效改变Th17、Treg含量,调节Th17/Treg细胞平衡,且安全性较高。

Objective To investigate the effects of high-dose immunoglobulin combined with glucocorticoids on peripheral blood Th17 cell levels in children with immune thrombocytopenia(ITP).Methods A total of 78 children with ITP who were admitted were enrolled.Using random number table method,they were divided into medium-dose group(routine-dose immunoglobulin and glucocorticoid,n=38)and high-dose group(high-dose immunoglobulin combined with glucocorticoid,n=40).The clinical effects of the two groups were compared.Changes in levels of peripheral blood helper T cell 17(Th17)and regulatory T cells(Treg)before and after treatment in both groups were observed.Th17/Treg was calculated,and drug safety of the two groups was compared.Results The total effective rate in the high-dose group was significantly higher than that in the middle-dose group(P<0.05).Compared with the same group before treatment,Th17 and Th17/Treg in the two groups after treatment were obviously decreased,while Treg was significantly increased;however,Th17 and Th17/Treg in the high-dose group after treatment were significantly lower than those in the middle-dose group,while Treg was significantly higher than that in the middle-dose group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups[17.50%(7/40)vs 10.53%(4/38)](χ2=0.782,P>0.05).Conclusion High dose immunoglobulin combined with glucocorticoid in the treatment of immune thrombocytopenia has a significant clinical effect and high safety,which can effectively change the content of Th17 and Treg,regulate the balance of Th17/Treg cells.