儿童免疫性血小板减少症患者外周血B淋巴细胞亚群变化的研究

目的 探讨儿童免疫性血小板减少症患者(immune thrombocytopenia,ITP)外周血中CD38,CD27,CD19表达阳性的B淋巴细胞亚群的变化及临床意义。方法 选取2017年1月～12月中山大学孙逸仙纪念医院收治的初诊ITP患儿21例为初诊未治疗组(untreated ITP,U-ITP),完全缓解ITP患儿30例为完全缓解组(remission ITP,R-ITP)及同期健康体检儿童26例为健康对照组(normal control,NC),运用流式细胞术对其外周血B淋巴细胞亚群进行检测并与ITP患儿的PLT计数进行相关性分析。结果 外周血总CD19+B淋巴细胞比例:U-ITP组显著高于R-ITP组和NC组(F=7.543,P<0.01)。外周血CD19+CD27+CD38-记忆性B细胞占CD19⁺B细胞百分率:U-ITP组显著高于R-ITP组和NC组(F=8.876,P<0.001)。CD19⁺CD27-CD38^-初始B细胞占CD19⁺B细胞百分率:U-ITP组显著低于R-ITP组)和NC组(F=5.058,P<0.01)。CD19⁺CD27⁺CD38⁺浆母细胞百分率:U-ITP组显著高于R-ITP组和NC组(F=9.588,P<0.001),而R-ITP组与NC组比较,B淋巴细胞各分群差异均无统计学意义(F=0.842～1.258,均P>0.05)。PLT计数与总CD19⁺ B细胞百分率呈负相关(r=-0.318,P=0.007),与CD19⁺CD27⁺CD38^-记忆性B细胞百分率呈负相关(r=-0.444,P=0.000),与CD19⁺CD27^-CD38^-初始B细胞百分率呈正相关(r=0.416,P=0.000),与CD19⁺CD27⁺CD38⁺浆母细胞百分率呈负相关(r=-0.442,P=0.000)。结论 B淋巴细胞亚群在ITP患儿体内分布存在异常,其检测能够为ITP患儿临床疾病监测与判断预后提供重要的指导作用。

B Lymphocyte Subsets in Peripheral Blood of Patients with Pediatric Immune Thrombocytopenia

Objective To investigate the change and clinical significance of B lymphocyte subsets marked by CD38,CD27 and CD19 in peripheral blood of pediatric patients with immune thrombocytopenia.MethodsA total of 51 ITP patients(21 patients were newly diagnosed and untreated.30 patients were in remission)were collected from January 2017 to December 2017 in Sun Yat-Sen Memorial Hospital,and 26 normal controls were enrolledin this study.The abnormal of B lymphocyte subsets in peripheral blood of research cohort were detected by flow cytometry and their correlations with plateletcount were analyzed.Results The percentage of total CD19⁺B cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls(F=7.543,P<0.01).The percentage ofmemory B cells in CD19⁺B cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls(F=8.876,P<0.001).The percentage of naive B cells in CD19⁺B cells of untreated ITP patients was significantly lower than that of remission ITP patients and normal controls(F=5.058,P<0.01).The percentage of plasmablasts cells of untreated ITP patients was significantly higher than that of remission ITP patients and normal controls(F=9.588,P<0.001).There was no significant difference in Blymphocyte subsets between remission ITP patients and the normal controls(F=0.842～1.258,all P>0.05).The PLT count had significantly negative correlation with the percentage of total CD19⁺B cells(r=-0.318,P=0.007),memory B cells(r=-0.444,P=0.000),plasmablasts cells(r=-0.442,P=0.000)and had significantly positive correlation with naive B cells(r=0.416,P=0.000).Conclusion The distribution of B lymphocytesubsets was abnormal in ITP patients.The detection of B lymphocyte subsets canbe used as a useful indicator of clinical disease surveillance and prognosis inITP patients.