原发性免疫性血小板减少症儿童调节性B细胞及淋巴细胞亚群免疫功能失调

Immune dysfunction of regulatory B cells and lymphocyte subsets in children with primary immune thrombocytopenia

目的探讨原发性免疫性血小板减少症(ITP)患儿的调节性B细胞(Bregs)及淋巴细胞亚群的改变,并分析其与ITP持续时间和缓解时间的关系。方法流式细胞术检测88例ITP患儿治疗前和其中84例治疗1个月后和45例正常对照者外周血淋巴细胞亚群及Bregs的比例。采用包括糖皮质激素和静脉注射IgG作为一线药物治疗ITP患儿。对比治疗后不同缓解时间ITP患儿淋巴细胞亚群的改变。结果与对照组相比,所有ITP患儿的Th、NK、Breg细胞计数和Th/Tc比值均明显降低(P<0.05),而Tc以及CD19+B细胞增高(P<0.05)。持续性和慢性ITP组Breg细胞计数较新诊断ITP组明显降低(P<0.05)。共84例ITP患儿治疗后缓解,58例(69.1%)获得长期缓解,26例(30.9%)短期缓解,短期缓解组治疗后Breg和淋巴细胞亚群与治疗前无明显差异(P>0.05),而与对照组仍有明显差异(P<0.05);长期缓解ITP组治疗后Breg和淋巴细胞亚群与对照组无明显差异(P>0.05),而与治疗前比较,除Tc之外,其他细胞亚群均明显增高(P<0.05);长期缓解ITP组NK细胞和Breg细胞明显高于短期缓解ITP组(P<0.05)。结论长病程ITP患儿外周血Bregs明显降低,治疗后获得长期缓解ITP患儿的外周血Bregs显著增加,表明恢复Bregs的免疫机制可能与儿童ITP的长期缓解有关。

Objective To investigate the changes of regulatory B cells(Bregs)and lymphocyte subsets in children with primary immune thrombocytopenia(ITP),and to analyze their relationship with ITP duration and remission time.Methods Proportion of different immune cell subsets were detected in the peripheral blood of 88 ITP children before treatmen,84 ITP children after treatmen and 45 normal controls by flow cytometry.The treatments included glucocorticoids,intravenous IgG as first-line treatment.The changes of lymphocyte subsets in ITP children with different remission time after treatment were compared.Results The Th,natural killer(NK),Breg cell counts and Th/Tc ratio in all children with ITP were significantly lower than those in the control group(P<0.05),while the Tc and CD19+B cells were significantly higher than those in the control group(P<0.05).The Breg cell count in the persistent and chronic ITP groups was significantly lower than that in the newly diagnosed ITP(P<0.05).A total of 84 children with ITP were relieved after treatment:58 cases(69.1%)achieved long-term remission,and 26 cases(30.9%)had short-term remission.The Breg and lymphocyte subsets in the short-term remission ITP group after treatment were not significantly different from those before treatment,but there were still significant differences from the control group(P<0.05);The Breg and lymphocyte subpopulations in the long-term remission ITP group after treatment were not significantly different from those in the control group,but compared with those before treatment,other cell subpopulations except Tc were significantly increased(P<0.05);The NK cells and Breg cells in the long-term remission ITP group were significantly higher than those in the short-term remission ITP group(P<0.05).Conclusions The Bregs in peripheral blood of long-duration ITP children significantly decrease.After treatment,the Bregs in ITP children with long-term remission increase significantly,indicating that the restoration of the immune mechanism of Bregs may be related to the long-term remission of children with ITP.