静注免疫球蛋白及地塞米松对特发性血小板减少性紫癜患儿免疫功能的影响

探讨大剂量地塞米松 (DEX)及静注免疫球蛋白 (IVIG)治疗 ,对特发性血小板减少性紫癜 (ITP)患儿外周血 T淋巴细胞亚群及免疫球蛋白的影响 ,在以DEX、IVIG治疗 ITP患儿 ,治疗前后各抽血一次 ;以 APAAP法测定 T淋巴细胞亚群 ,以单向琼脂免疫扩散法测定免疫球蛋白。结果表明 1.ITP患儿外周血 CD4+ 降低 ,CD8+增高 CD4+ /CD8+ ,显著降低。单纯 DEX组治疗后 ,CD4+、CD8+均显著降低 ,CD4+ /CD8+升高 ,Ig A、Ig G、Ig M降低 ;单纯 IVIG组治疗后 ,CD8+显著降低 ,CD4+ /CD8+升高 ,Ig G显著升高。2 .单纯 DEX组治疗后 ITP患儿外周血白细胞计数显著高于治疗前 ,单纯 IVIG组与 IVIG加 DEX组治疗前后无显著差异。治疗过程中院内交叉感染率单纯 DEX组为 31.43% ,单纯 IVIG治疗组为 2 5 % ,IVIG加 DEX组为2 8.5 7%。因此 ,本文认为 ITP患儿外周血 T淋巴细胞亚群表达异常 ,IVIG及 DEX治疗均干扰了 ITP患儿机体的免疫状态

EFFECT OF INTRAVENOUS IMMUNOGLOBULINS AND DEXAMETHASONE ON IMMUNITY OF PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA

To investigate the changes in T lymphocyte subsets and immunoglobulins in patients with idiopathic thrombocytopenic purpura (ITP) after therapy of high dose intravenous immunoglbulins (IVIG) and dexamethasome(DEX). The blood samples were collected in ITP patients prior to and post IVIG and DEX treatment. T lymphocyte subests were examined by APAAP method and immungloblins were masured by simple agar diffusion test. Results showed :compared to normal comtrols, these ITP patients showed an elevation in percentage of CD + 8 cells, but decrease in CD + 4 cells as well as ratio of CD + 4/CD + 8 in peripheral blood. After DEX treatment, the percentage of CD + 4 cells and CD + 8 cells in peripheral bolld, as well as serum levels of IgA, IgG and IgM were obviously low, while the ratio of CD + 4/CD + 8 was significantly increased. After IVIG therapy for ITP patient, the expression of CD + 8 cells was profoundly increased. After IVIG therapy for ITP patient, the expression of CD + 8 cells was profoundly inhibited, but the ration of CD + 4/CD + 8 and serum levels of IgG were increased significantly. 2.Leucocyte counts in peripheral blood were obviously high after DEX therapy for ITP patients, but they showed no singificant difference between pure IVIG group with IVIG and DEX group, The hospital infection rates were 31.43% in DEX group, 25% in IVIG group and 28.57% in IVIG and DEX group. Therefore T lymphocyte subsets in peripheral blood of ITP patients expressed abnormally. Both of IVIG and DEX could influence the immunity of ITP patients. (Original article on pape 202)