浆母细胞在成人原发免疫性血小板减少症中的表达特征及临床价值

Expression characteristics and clinical value of plasmablast cells in adult primary immune thrombocytopenia

目的探讨成人原发免疫性血小板减少症(ITP)患者外周血中浆母细胞的表达特征及在疾病诊断中的价值。方法选取2022年7—12月来复旦大学附属中山医院就诊的20例ITP患者和20例继发其他各种疾病导致血小板减少患者(非ITP血小板减少患者)分别作为ITP组和非ITP血小板减少组,并选取同期24例体检健康者作为健康对照组。应用流式细胞术检测各组外周血B淋巴细胞亚群并比较其差异,采用Logistic回归分析ITP发生的风险因素。结果与健康对照组比较,ITP组浆母细胞(CD19^(+)CD27^(++)CD38^(++))占CD19^(+)细胞比例显著上升,差异有统计学意义(P<0.05),其余淋巴细胞亚群指标比较差异无统计学意义(P>0.05)。与健康对照组比较,非ITP血小板减少组初始B细胞(CD19^(+)CD27^(-)CD38^(-))占CD19^(+)细胞比例显著上升,记忆B细胞(CD19^(+)CD27+CD38^(-))占CD19^(+)细胞比例均显著下降,差异有统计学意义(P<0.01),浆母细胞比例差异无统计学意义(P>0.05)。与非ITP血小板减少组比较,ITP组浆母细胞(CD19^(+)CD27^(++)CD38^(++))、记忆B细胞(CD19^(+)CD27+CD38^(-))占CD19^(+)细胞比例均显著上升,初始B细胞(CD19^(+)CD27^(-)CD38^(-))占CD19^(+)细胞比例下降,差异有统计学意义(P<0.05)。Logistic回归分析显示,当模型未校准时,OR=3.31,P<0.01;校准性别、年龄后,ITP发生的风险增加2.65倍(OR=3.65,P<0.01);进一步校准性别、年龄和血小板计数后,ITP发生的风险增加3.78倍(OR=4.78,P<0.01)。结论外周血浆母细胞升高是成人ITP发生的独立风险因素。

Objective To investigate the expression characteristics of plasmablast cells in peripheral blood of adult with primary immune thrombocytopenia(ITP)and its diagnostic value.Methods A total of 20 patients with ITP and 20 patients with secondary diseases resulting in thrombocytopenia(non-ITP thrombocytopenia)who visited Zhongshan Hospital,Fudan University from July to December 2022 were selected as ITP group and non-ITP thrombocytopenia group,respectively.Additionally,24 individuals undergoing health examinations during the same period were chosen as healthy control group.Flow cytometry was used to detect B-lymphocyte subsets in peripheral blood of each group and the differences were compared.The risk factors of ITP were analyzed by Logistic regression.Results Compared with the healthy control group,the proportion of plasmablast cells(CD19^(+)CD27^(++)CD38^(++))in CD19^(+)cells in ITP group was significantly increased(P<0.05),and the other lymphocyte subsets indicators were not statistically significant(P>0.05).Compared with healthy control group,the proportion of initial B cells(CD19^(+)CD27^(-)CD38^(-))in CD19^(+)cells in non-ITP thrombocytopenia group was significantly increased,and the proportion of memory B cells(CD19^(+)CD27^(+)CD38^(-))in CD19^(+)cells was significantly decreased,with statistical significance(P<0.01).There was no significant difference in the proportion of plasmablast cells(P>0.05).Compared with non-ITP thrombocytopenia group,the proportion of plasmablast cells(CD19^(+)CD27^(++)CD38^(++))and memory B cells(CD19^(+)CD27+CD38^(-))in CD19^(+)cells increased significantly in ITP group,while the proportion of initial B cells(CD19^(+)CD27^(-)CD38^(-))in CD19^(+)cells decreased,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that when the model was not calibrated,OR=3.31,P<0.01;after adjusting gender and age,the risk of ITP was increased by 2.65 times(OR=3.65,P<0.01);after further adjustment for gender,ag e,and platelet count,the risk of ITP was increased by 3.78 times(OR=4.78,P<0.01).Conclusion Elevated levels of peripheral blood plasmablast cells are an independent risk factor for the occurrence of ITP in adults.