儿童慢性特发性血小板减少性紫癜免疫紊乱与治疗

目的探讨儿童慢性特发性血小板减少性紫癜(1TP)自身免疫的病理机制,以及α-2b干扰素的治疗效果。方法慢性ITP组18例,健康儿童17例,均采用流式细胞术检测外周T淋巴细胞亚群,以及免疫荧光抗体双标记法检测单个核细胞内Th1/Th2细胞因子的表达情况;18例慢性ITP病人均给予α-2b干扰素治疗,总疗程3个月。结果儿童慢性ITP患者存在T淋巴细跑表型及功能异常,其外周血CD4+减少,CD8+升高,CD4+/CD8+明显降低;且Th1/Th2功能失衡,是一种Th2优势疾病。本组18例应用α-2b干扰素治疗,其中显效6例,良效4例,进步3例,无效5例。结论儿童ITP是一种自身免疫性疾病,T淋巴细胞表型和功能异常在慢性ITP的发病中起重要作用。α-2b干扰素治疗可使患儿Th1细胞因子产生增加,而Th2细胞因子产生减少,因而抑制B淋巴细胞产生抗血小板抗体;α-2b干扰素价格低廉,毒付作用轻,应用方便,为儿童慢性ITP开辟了另一条治疗途径。

Immune abnormalities and treatment of children with chronic idiopathic thrombocytopenic purpura

Objective To discuss the autoimmune mechanism of children with chronic idiopathic thrombocytopenic purpura (ITP) and investigate the efficacy of α-interferon therapy. Methods T-lymphocyte subsets and expression of cytokines were examined in 18 children with chronic ITP compared with 17 healthy children by flow cytometry using monoclonal antibodies, α-interferon therapy was used in all patients for 3 months. Results the children with chronic ITP had abnormal phenotype and function of T-lymphocyte subsets. Lower CD_4~+ cells, CD_4~+/CD_8~+ ratio and higher CD_8~+ cells were found in these patients. There was an imbalance profile of Th_1/Th_2. In 18 patients receiving α-interferon, 6 patients had complete response; 4 patients good response; 3 patients partial response and 5 patients no response.Conclusion ITP in children is an autoimmune disorder. Abnormal phenotype and function of T-lymphocyte subsets plays an important role in chronic ITP. Th_1 type cytokines were increased after α-interferon therapy as Th_2 type cytokines tended to be suppressed by α-interferon. α-interferon treatment is safer and cheaper than other therapies. It is an alternative therapeutic strategy in children with chronic ITP.