全反式维甲酸治疗难治性特发性血小板减少性紫癜疗效观察及其机制探讨

目的探讨加用全反式维甲酸（ATRA）对难治性特发性血小板减少性紫癜（RITP）的疗效及对患者外周血调节性T（CD4＋CD25highT）细胞表达和辅助性T（Th）细胞因子的影响。方法应用流式细胞术测定28例RITP患者ATRA治疗前后及17名正常人外周血CD4＋CD25highT细胞的表达;ELISA法测定血清中转化生长因子β1（TGF-β1）、白介素10（IL-10）、IL-4、IL-2、干扰素γ（IFN-γ）。结果ATRA对RITP总有效率为53.6%。治疗有效组治疗后患者外周血小板计数从（25.7±9.6）×109/L升至（109.1±30.1）×109/L（P〈0.01）,差异有高度统计学意义（P〈0.01）;有效组治疗后患者CD4＋CD25highT细胞阳性率及血清TGF-β1、IFN-γ水平明显高于治疗前,IL-4则明显低于治疗前,差异均有统计学意义（均P〈0.05）;IL-2和IL-10在治疗后未见改变。结论ATRA对半数以上RITP患者有效,可能是通过提高调节性T细胞的表达,促进了RITP患者的免疫紊乱向生理性平衡恢复。

Therapeutic Effect and Mechanism of AIl-trans-retinoic Acid Treatment in Refractory Idiopathic Thrombocytopenic Purpura

Objective To explore therapeutic effects of all -trans -retinoic acid （ATRA）on refractory idiopathic thrombocytopenic purpura （RITP）and to investgate the alterations of CD4＋CD25high T cells in peripheral blood and cytokines serected by T -helper cells. Methods The count of CD4＋ CD25high T cells in peripheral blood was detected by flow cytometry, and the levels of sera transforming growth factor-beta 1 （TGF-β1）, interleukin （IL）-10 IL-4, IL-2 and interferon （IFN）-γ were detected by ELISA in 28 patients with RITP before and after treatment of all-trans-retinoic acid （ATRA） and in 17 control cases. Results The overall response rate of ATRA treatment in patients with RITP was 53.6%, the mean platelet counts increased from （25.7±9.6）×10^9/L to （109.1±30.1）×10^9/L in the improved patients （P〈0,01）; the counts of CD4＋CD25^high T cells in the improved group after treatment were significantly higher than that before treatment （P〈0.05）; the levels of sera TGF-β1 and IFN-γ in the improved group were increased （P〈0.05）, while the IL-4 was decreased （P〈0.05）. However, the IL-10 and IL-2 were not significantly changed during ATRA trerapy period. Conclusion 53.6% of patients with RITP was partically or completely recovered after ATRA treatment, which may increase the counts of CD4＋CD25＋high T cells in peripheral blood, and keep the physiologic balance from immune disturbance.