【摘要】 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(CD 4⁺CD 25^highT)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例正常人外周血CD 4⁺ CD 25^highT细胞的表达;ELISA法测定血清中转化生长因子β1（TGF-β1）、白介素（IL）-10、IL-4、IL-2、干扰素γ（IFN-γ）。结果ATRA对RITP的总有效率为53.6%,有效组治疗后患者外周血血小板计数达109.1±30.1×10⁹/L,较治疗前明显升高（P<0.01）;治疗有效组经ATRA治疗后CD 4⁺ CD 25^highT细胞阳性率及血清TGF-β1与IFN-γ水平高于治疗前（P<0.05）;IL-4则明显低于治疗前（P<0.05）;IL-2和IL-10治疗前后未见异常。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患者免疫紊乱向生理性平衡恢复。更多还原

【Abstract】 Objective To explore therapeutic effect of all- trans- retinoic acid（ATRA） treatment in refractory idiopathic thrombocytopenic purpura（RITP） and to investgate the alteration of peripheral blood CD 4 ⁺ CD 25^highT cell and serum cytokines after ATRA treatment.Methods The expression of peripheral blood CD 4 ⁺ CD 25^highT cells was detected by flow cytometry and the concentrations of serum transforming growth factor （TGF） -β1,interleukin（IL）-10,IL-4,IL-2,interferon（IFN）-γwere detected by ELISA of 28 RITP patients before and after treatment and 17 normal individuals as controls.Results The overall response rates of ATRA treatment in RITP patients was 53.6%,the mean platelets count after treatment reached 109.1±30.1 10⁹/L,which was remarkable more than before（P<0.01 ）.The expression of CD4 ⁺ CD25^highT cells in improved group after treatment was significantly higher than that before treatment（P<0.05）;the concentrations of serum TGF-β1 and IFN-γin improved group were increased（P<0.05）;while the concentration of serum IL-4 was decreased in the improved group after treatment（P<0.05 ）.However,the concentrations of serum IL-10 and IL-2 were not changed during ATRA therapy period.Conclusion 53.6%of RITP patients were completely or partially recovered after ATRA treatment.ATRA may increase the expression of CD 4 ⁺ CD 25^high T cells in peripheral blood through TGF-β1,reduce the concentration of IL-4 and increase the concentration of IFN-γ.All these effects would restore the physiologic balance from immune disturbance.更多还原