地塞米松治疗对免疫性血小板减少症患儿机体免疫指标的影响

Effect of dexamethasone on immune function in children with immune thrombocytopenia

目的探讨地塞米松治疗对免疫性血小板减少症(immune thrombocytopenia,ITP)患儿免疫指标的影响。方法选取济宁医学院附属医院2019年2月至2022年2月接诊的80例初治慢性ITP患儿作为研究组,另选同期健康体检的100名儿童作为对照组,研究组在患儿大剂量地塞米松治疗后流式细胞术(flow cytometry,FCM)检测T淋巴细胞亚群和树突细胞(dendritic cell,DC)亚群表达,分析对照组,研究组治疗前后上述细胞细胞与地塞米松疗效之间的关系。结果研究组患儿治疗前CD3^(+)、CD4^(+)以及CD4^(+)/CD8^(+)均明显低于对照组,而CD8^(+)水平明显高于对照组,差异具有统计学意义[(62.35±9.21)%比(70.14±5.25)%,(30.58±7.58)%比(37.98±3.05)%,(1.29±0.88)比(1.53±0.18),(30.58±9.14)%比(24.69±1.25)%,t值分别7.14,8.91,2.66,6.37,P值均<0.05);地塞米松治疗后有效组、无效组及对照组CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)比较,差异具有统计学意义[(37.35±9.11)%比(65.25±9.47)%比(70.14±5.25)%,(29.58±7.66)%比(38.05±4.05)%比(37.98±3.05)%,(35.58±9.58)%比(20.18±6.74)%比(24.69±1.25)%,(1.09±0.65)比(2.14±0.78)比(1.53±0.18),F值分别为369.89,53.38,81.61,42.49,P值均<0.05];研究组治疗前DC2水平高于治疗后有效组和对照组[(0.30±0.15)%比(0.14±0.09)%比(0.13±0.07)%,F=62.96,P<0.05],但三组DC1水平差异无统计学差异[(0.25±0.11)%比(0.27±0.13)%比(0.27±0.09)%,F=0.92,P>0.05]。结论T细胞亚群和DC细胞亚群检测可评估ITP患儿血小板破坏的程度,为ITP的治疗提供参考依据。

Objective To detect the effect of dexamethasone on the immune function indexes of children with chronic immune thrombocytopenia(ITP).Methods Total of 80 newly treated cases with chronic ITP admitted to the Affiliated Hospital of Jining Medical University from February 2019 to February 2022 were selected as the study group,and 100 healthy children in the same period were selected as the control group.The expressions of T lymphocyte subsets and endritic cell(DC)subsets were detected by flow cytometry(FCM)after high-dose dexamethasone treatment,and the relationship between the cells and the efficacy of dexamethasone before and after treatment in the control group and the study group was analyzed.Results Before treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the study group were lower than this in the control group,while the levels of CD8^(+)were significantly higher than those in the control group[(62.35±9.21)%vs(70.14±5.25)%,(30.58±7.58)%vs(37.98±3.05)%,(1.29±0.88)vs(1.53±0.18),(30.58±9.14)%vs(24.69±1.25)%,t values were 7.14,8.91,2.66,6.37,respectively all P values<0.05.The differences of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between the effective group,the ineffective group and the control group were statistically significant[(37.35±9.11)%vs(65.25±9.47)%vs(70.14±5.25)%,(29.58±7.66)%vs(38.05±4.05)%vs(37.98±3.05)%,(35.58±9.58)%vs(20.18±6.74)%vs(24.69±1.25)%,(1.09±0.65)vs(2.14±0.78)vs(1.53±0.18),F were 369.89,53.38,81.61,42.49,respectively all P values<0.05].The DC2 of the study group before treatment was higher than that of the effective group and the control group[(0.30±0.15)%vs(0.14±0.09)%vs(0.13±0.07)%,F=62.96,P<0.05],there was no significant difference in DC1 level among the three groups[(0.25±0.11)%vs(0.27±0.13)%vs(0.27±0.09)%,F=0.92,P>0.05].Conclusion The detection of T cell subsets and DC cell subsets can evaluate the degree of platelet destruction in children with ITP,and may provide reference for the treatment of ITP.