特发性血小板减少性紫癜患者单个核细胞PD-1/PD-Ls的变化及临床意义

目的探讨特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura，ITP)患者外周血程序性死亡因子PD-1及其配体(PD-Ls)的变化及临床意义。 方法收集26例初诊为急性ITP成人患者治疗前、治疗后3个月、6个月以及1年的外周血标本，用流式细胞术检测其外周血T淋巴细胞和单核细胞上分子(CD273、CD274和CD279)的表达水平；对各项指标进行相关性分析和随机区组的方差检验。 结果与ITP患者治疗前相比，治疗后3个月、6个月以及1年的患者单核细胞PD-Ls表达水平均显著性下降(P<0.05)；与治疗后3个月相比，治疗后6个月以及1年的患者CD8^＋T淋巴细胞PD-1表达显著性升高(P<0.05)；相关性分析显示ITP患者中单核细胞PD-Ls表达与CD8^＋T淋巴细胞的PD-1呈正相关(P<0.01)。 结论ITP患者治疗过程中血小板数量的变化与单个核细胞PD-1/PD-Ls的表达水平存在关联性，证实PD-1/PD-Ls可作为观察ITP疗效的动态指标。

Changes and clinical significance of PD-1 and PD-Ls in mononuclear cells in patients with idiopathic thrombocytopenic purpura

ObjectiveTo investigate the changes and clinical significance of programmed death factor (PD-1) and its ligand (PD-Ls) in peripheral blood mononuclear cells of patients with idiopathic thrombocytopenic purpura (ITP). MethodsThe expressions of T lymphocytes and monocyte supramolecular molecules (CD273, CD274 and CD279) in peripheral blood of 26 adult patients with acute ITP were detected by flow cytometry before treatment, and 3 months, 6 months and one year after treatment. Correlation of each indice and variance tests of random block was analyzed. ResultsCompared with ITP patients before treatment, the expression of PD-Ls in monocytes decreased significantly at 3 months, 6 months and one year after treatment (P<0.05), while the expression of PD-1 in CD8⁺ T lymphocytes increased significantly at 6 months and one year after treatment (P<0.05). Correlation analysis showed that the expression of PD-Ls in monocytes was positively correlated with PD-1 expression in CD8⁺ T lymphocytes (P<0.01). ConclusionThe platelet count in patients with ITP were correlated with the expression of PD-1 and PD-Ls in mononuclear cells, which proved that PD-1 and PD-Ls could be used as a dynamic index to observe the therapeutic effect of ITP.