免疫性血小板减少症患者的细胞免疫功能研究

目的探讨免疫性血小板减少症（ITP）患者免疫功能状态。 方法选取2016年5月至2017年2月在中国中医科学院西苑医院与北京中医药大学东方医院门诊就诊的ITP确诊患者40例，其中慢性22例（慢性组）、新诊断9例（新诊断组）、持续性9例（持续性组），24名健康者作为对照（对照组）。应用流式细胞仪分析Th1、Th2、Th17、Treg、Breg细胞的表达。ITP组与对照组比较采用Wilcoxon检验，多组之间的比较采用Kruskal-Wallis检验。 结果ITP患者Th1、Th1/Th2高于健康对照组[（16.88±9.02）% vs（8.83±5.30）%、（10.9±9.08）% vs（4.61±3.13）%]，差异具有统计学意义（Z=-3.753，P=0.001；Z=-3.596，P=0.001），Th17、Breg、Th17/Treg低于对照组[（1.02±0.37）% vs（1.41±0.38）%、（1.35±1.37）% vs（2.07±0.86）%、（1.01±0.37）% vs（0.3±0.05）%]，差异具有统计学意义（Z=-3.141，P=0.002；Z=-5.963，P=0.001；Z=-1.693，P=0.009）。新诊断组、持续性组和慢性组3组的Th1、Th1/Th2均高于健康对照组[（16.12±7.72）% vs（13.11±3.83）% vs（18.75±10.38）% vs（8.83±5.3）%、（11.63±8.77）% vs（7.77±3.43）% vs（12.03±10.65）% vs（4.61±3.13）%]，差异具有统计学意义（Z=14.83，P=0.002；Z=13.363，P=0.004）；3组的Th17、Breg、Th17/Treg均低于健康对照组[（0.91±0.28）% vs（0.98±0.54）% vs（1.07±0.33）% vs（1.41±0.38）%、（1.77±1.58）% vs（1.14±0.52）% vs（1.26±1.54）% vs（2.07±0.86）%、（0.15±0.07）% vs（0.16±0.09）% vs（0.18±0.01）% vs（0.3±0.05）%]，差异具有统计学意义（Z=10.04，P=0.018；Z=35.731，P=0.001；Z=3.200，P=0.030）；3组Th2细胞和Treg细胞与健康对照组比较差异均无统计学意义（P>0.05）。3组之间Th1、Th1/Th2、Th17、Breg、Th17/Treg等指标比较差异均无统计学意义（P>0.05）。 结论ITP免疫发病机制包括T和B细胞功能紊乱，T细胞表现为Th1/Th2与Th17/Treg失衡。不同分型ITP患者免疫细胞表现差异性不明显。

Cellular immune function in patients with immune thrombocytopenia

ObjectiveTo observe the changes of immune function in patients with immune thrombocytopenia (ITP). MethodsFrom May 2016 to February 2017, 40 patients with ITP were enrolled at the Xiyuan Hospital and Dongfang Hospital. Twenty-four healthy persons were also included. The 40 ITP patients were classified into three groups: a chronic group (CG; n=22), a newly diagnostic group (NG; n=9), and a persistent group (PG; n=9). The expression of Th1, Th2, Th17, Treg, and Breg was detected by flow cytometry. Wilcoxon test was used to analyze the difference between the ITP group and the control group (COG), while Kruskal-Wallis test was used for multi-group comparisons. ResultsIn comparison with the COG, the expression of Th1 [(16.88±9.02)% vs (8.83±5.3)%, Z=-3.753, P=0.001] and Th1/Th2 ratio [(10.98±9.08)% vs (4.61±3.13)%, Z=-3.596, P=0.001] in patients with ITP were higher, while the levels of Th17 [(1.02±0.37)% vs (1.41±0.38)%, Z=-3.141, P=0.002], Th17/Treg [(1.01±0.37)% vs (0.3±0.05)%, Z=-1.693, P=0.009], and Breg [(1.35±1.37)% vs (2.07±0.86)%, Z=-5.963, P=0.001)] were significantly lower. The expression of Th1 in the CG [(18.75±10.38)%], NG [(16.12±7.72)%], or PG [(13.11±3.83)%] was significantly higher than that in the COG [(8.8±5.3)%, Z=14.83, P=0.002]. Th1/Th2 ratio in the CG [(12.03±10.65)%], NG [(11.63±8.77)%], or PG [(7.77±3.43)%] was significantly higher than that in the COG [(4.61±3.13)%, Z=13.363, P=0.004]. The expression of Th17 in the CG [(1.07±0.33)%], NG [(0.91±0.28)%], or PG [(0.98±0.54)%] was significantly lower than that in the COG [(1.41±0.38)%, Z=10.040, P=0.018]. Th17/Treg ratio in the CG [(0.18±0.01)%], NG [(0.15±0.07)%], or PG [(0.16±0.09)%] was significantly lower than that in the COG [(0.3±0.05)%, Z=3.200, P=0.03]. The expression of Breg in the CG [(1.26±1.54)%], NG [(1.77±1.58)%], or PG [(1.14±0.52)%] was also significantly lower than that in the COG [(2.07±0.86)%, Z=35.731, P=0.001]. There was no difference in the expression of Th2 or Treg between patients with ITP and healthy persons (P>0.05). ConclusionBoth T and B cell dysfunctions are involved in the pathogenesis of ITP. T cell dysfunction manifests mainly as Th1/Th2 and Th17/Treg imbalance. There is no significant difference in immune cells between different subtypes of ITP patients.