儿童特发性血小板减少性紫癜免疫细胞数量变化及临床意义

目的了解儿童特发性血小板减少性紫癜（ITP）外周静脉血T淋巴细胞亚群和B淋巴细胞的变化及临床意义。方法采用免疫荧光标记流式细胞仪对38例ITP病儿（急性组18例，慢性组20例）和30例对照组儿童外周血免疫细胞的数量进行动态检测。结果ITP病儿慢性组CD4数量明显低于对照组和急性组（t=7．08，5．51，P〈0．001），急性、慢性两组CD8数量均明显高于对照组（t=4．11，4．93，P〈0．001）；急性、慢性两组病儿CD19和CD3^-／HLA—DR^＋数量均明显高于对照组（t=4．37，7．25，8．08，7．22，P均〈0．001），慢性组CD19高于急性组（t=2．18，P〈0．05）。CD4／CD8比值倒置病儿的CD19和CD3^-／HLA—DR^＋数量与比值正常病儿的比较在急性、慢性两组中均示差异无统计学意义（t=1．99，0．64，1．63，1．44，P均〉0．05）。经激素或大剂量丙种球蛋白治疗后在血小板恢复正常的病儿CD8数量明显低于治疗前（t=3．68，P〈0．01），8周后T细胞亚群、B淋巴细胞恢复正常。结论T淋巴细胞亚群、B淋巴细胞的紊乱参与了ITP的发生发展过程，B淋巴细胞数量升高比T淋巴细胞亚群变化更能反映出病儿机体的免疫状态。ITP病儿血小板数量正常后的一段时间内仍存在T淋巴细胞亚群和B淋巴细胞异常。

Quantity Change and Its Clinical Significance of Immunological CeiLs in Clildren with Idiopathic Thrombocytopenic Purpura

Objective To study the change and its clinical significance of T and B lymphocytes in children with idiopathic thrombocytopenic purpura （ITP）. Methods T and B lymphocytes were detected by flow cytometry in 38 children with ITP （ 18 cases of acute ITP and 20 cases of chronic ITP） and 30 normal controls. Results Tile children with ITP had abnormalities in T - lymphocyte subsets. The number of CD4 in chronic ITP group was significantly lower than that in control and acute ITP group （ t =7.08, 5.51, P 〈 0. 001 ） , and the number of CD8 was significantly higher than that in control and acute ITP group （ t = 4. 11, 4. 93, P 〈 0. 001 ）. All patients had the abnormalities of B - lymphocyte, the numbers of CD19 and CD3^- / HLA - DR^＋ cells in patients with acute or chronic ITP were all significantly higher than that in control group （ t = 4. 37, 7.25, 8.08, 7.22, all P 〈 0. 001 ） , the number of CD19 in chronic ITP group was significantly higher than that in acute ITP group （t = 2. 18, P 〈 0. 05 ）. The numbers of CD19 and CD3^-/HLA -DR^＋ showed no significant differences in ITP patients with normal or abnormal ratio of CD4 to CD8. （ t = 1.99, 0. 64, 1.63, 1.44, all P 〉 0. 05）. The number of CD8 in ITP patients whose platelet counts had returned to normal level after therapy with corticoid and adequate dosage of IVIg was significantly lower than that of patients before therapy （ t = 3. 68, P 〈0.01 ）. After 8 weeks＇ therapy, both T - lymphocyte and B - lymphocyte counts had returned to normal levels. Conclusion Disturbances of T - lymphocyte and B - lymphocyte substets were involved in generation and development of ITP. Elevation of B - lymphocyte counts was more sensitive in reflecting immunological function. The abnormalities of B - lymphocyte and T - lymphocyte subsets still existed for some time even when the platelet count had returned to normal level after treatment in patients with ITP.