原发免疫性血小板减少症患者血清B7同源蛋白2、肿瘤坏死因子相关凋亡诱导配体、白细胞介素-37、白细胞介素-17A水平及临床意义

Serum B7 homologous protein 2,tumor necrosis factor-related apoptosis-inducing ligand,interleukin-37,interleukin-17A levels in patients with primary immune thrombocytopenia and their clinical significance

目的探讨原发免疫性血小板减少症(ITP)患者血清B7同源蛋白2(B7-H2)、肿瘤坏死因子相关凋亡诱导配体(TRAIL)、白细胞介素(IL)-37、IL-17A水平变化情况,并分析检测各指标在ITP诊疗中的临床指导意义。方法回顾性选取济宁市中医院2018年9月至2020年9月诊治的90例ITP患者作为研究组,另选取同期90例健康体检者作为正常对照组。比较两组血清B7-H2、TRAIL、IL-37、IL-17A及血小板计数(PLT)水平,分析检测各指标在ITP诊疗中的临床指导意义。结果研究组B7-H2、TRAIL、IL-37、IL-17A水平高于正常对照组[(25.12±4.29)μg/L比(12.26±3.10)μg/L、(0.92±0.20)μg/L比(0.46±0.13)μg/L、(145.02±43.18)ng/L比(50.23±14.07)ng/L、(21.63±5.06)ng/L比(7.71±2.04)ng/L],PLT低于正常对照组[(16.12±4.61)×10^(9)/L比(200.86±61.4)×10^(9)/L],差异有统计学意义(P<0.05)。研究组治疗3个月后缓解73例(缓解组),未缓解17例(未缓解组)。未缓解组治疗前、治疗后B7-H2、TRAIL、IL-37、IL-17A水平高于缓解组,PLT水平低于缓解组,差异均有统计学意义(P<0.05)。Pearson相关分析结果表明,治疗前、治疗后B7-H2、TRAIL、IL-37、IL-17A与PLT呈负相关(P<0.05)。受试者工作特征曲线分析结果表明,治疗前血清B7-H2、TRAIL、IL-37、IL-17A水平联合预测ITP疾病转归的曲线下面积为0.916,灵敏度、特异度分别为94.12%、86.30%。结论ITP患者血清B7-H2、TRAIL、IL-37、IL-17A水平明显升高,且与PLT水平密切相关,联合检测有助于临床预测疾病转归方向。

Objective To explore the changes of serum B7 homolog 2(B7-H2),tumor necrosis factor-related apoptosis-inducing ligand(TRAIL),interleukin(IL)-37 and IL-17A levels in patients with primary immune thrombocytopenia(ITP),and to analyze the clinical guiding significance of each index level in the diagnosis and treatment of ITP.Methods A total of 90 patients with ITP treated in Jining Hospital of Traditional Chinese Medicine from September 2018 to September 2020 were retrospectively selected as the research group,and 90 healthy patients during the same period were selected as the normal control group.The levels of serum B7-H2,TRAIL,IL-37,IL-17A and platelet count(PLT)in the two groups were compared,and the clinical guidance significance of each index level in the diagnosis and treatment of ITP were analyzed by receiver operating characteristic(ROC)curve.Results The serum levels of B7-H2,TRAIL,IL-37 and IL-17A in the research group were higher than those in the normal control group,and PLT was lower than that in the normal control group:(25.12±4.29)μg/L vs.(12.26±3.10)μg/L,(0.92±0.20)μg/L vs.(0.46±0.13)μg/L,(145.02±43.18)ng/L vs.(50.23±14.07)ng/L,(21.63±5.06)ng/L vs.(7.71±2.04)ng/L,(16.12±4.61)×10^(9)/L vs.(200.86±61.4)×10^(9)/L,there were statistical differences(P<0.05).After treatment for 3 months,73 patients obtained remission,and 13 patients were non-remission.The levels of B7-H2,TRAIL,IL-37,IL-17A in the non-remission group before and after treatment were higher than those in the remission group,and PLT was lower than that in the remission group,there were statistical differences(P<0.05).Pearson correlation analysis showed that the levels of serum B7-H2,TRAIL,IL-37 and IL-17A were negatively correlated with PLT(P<0.05).The ROC curve analysis showed that the area under the curve of serum B7-H2,TRAIL,IL-37 and IL-17A in prognostic prediction was 0.916,the sensitivity and the specificity were 94.12%and 86.30%.Conclusions The serum levels of B7-H2,TRAIL,IL-37 and IL-17A in patients with ITP are significantly elevated,and are closely related to the level of PLT.Combined detection can help clinically predict the direction of disease outcome.