免疫性血小板减少性紫癜患者脾脏T淋巴细胞亚群的变化

目的 探讨免疫性血小板减少性紫癜(ITP)患者脾脏T淋巴细胞亚群的变化及其临床意义.方法 收集2005年12月至2008年5月本科室收治的ITP患者47例,分为激素依赖(SD)组29例和激素抵抗(SR)组18例,以急诊外伤性脾破裂行脾切除术者12例作为对照组.免疫组化法检测脾脏组织标本CD3~+、CD4~+和CD8~+细胞的表达情况,观察脾脏组织动脉周围淋巴鞘(PALS)中染色阳性细胞的百分数,并计算CD4~+与CD8~+细胞的比值.分析3组CD3~+、CD4~+,CD8~+细胞百分数和CD4~+/CD8~+比值的差异. 结果3组间PALS中CD3~+、CD4~+细胞百分数差异均无统计学意义(均P>0.05).对照组PALS中CD8~+T淋巴细胞百分数低于SD组和SR组(28.70±22.19比43.80±20.77,49.27±14.10,均P<0.05),而CD4~+/CD8~+比值高于SD组和SR组(6.27±4.64比0.95±0.93,0.89±0.51,均P<0.05).SD组和SR组PALS中CD8~+细胞百分数及CD4~+/CD8~+比值的差异均无统计学意义(均P>0.05).结论 ITP患者脾脏细胞免疫存在异常.术前激素治疗反应性与脾脏T淋巴细胞亚群百分数的改变无明显关联.

Alteration of splenic T lymphocyte subsets in patients with immune thrombocytopenic purpura

Objective To investigate the alteration of T-lymphocyte subsets in splenic tissue and its clinical significance in patients with immune thrombocytopenic purpura (ITP).Methods Forty-seven patients with ITP treated in our department between December 2005 and May 2008 were recruited and allocated into the steroid-dependent group (SD group, n=29) and the steroid-resistant group (SR group, n= 18).Another 12 patients who underwent emergent splenectomy for traumatic spleen rupture were selected as controls.The expressions of CD3~+ cells, CD4~+ cells and CD8~+ cells in the specimens of the splenic tissue were detected by immunohistochemistry.The percentage of the positive staining cells around the periarterial lymphatic sheath (PALS) of the spleen was counted under the microscope.The ratio of CD4~+ cells and CD8~+ cells was calculated.The differential percentage of CD3, CD4 and CD8 positive ceils and CD4~+/CD8~+ ratio of 3 groups were analysed.Results No significant difference of the percentage of CD3~+ and CD4~+ cells in PALS was found among 3 groups (all P>0.05).The percentage of CD8~+ cells in PALS of control group was significantly lower than that in SD group and SR group (28.70±22.19 vs 43.80±20.77, 49.27±14.10, both P<0.05), and the CD4~+/CD8~+ ratio in PALS of control group was higher than that in SD group and SR group (6.27±4.64 vs 0.95±0.93, 0.89±0.51, beth P<0.05).There was no significant difference in the percentage of CD8~+ cells and the ratio of CD4~+/CD8~+ in PALS between SD and SR group (both P>0.05).Conclusions Abnormal cellular immunity of spleen is found in patients with ITP.No significant association is found between pre-operative response to steroids and alteration of T-lymphocyte subsets in the spleen.