【摘要】 目的验证并探讨CD4+CD25+调节性T细胞及Th17细胞与特发性血小板减少性紫癜发病的关系及可能机制。方法入选自2009年12月至2010年11月在山东省医学科学院附属济宁市第一人民医院血液内科门诊就诊或住院治疗的41例ITP患者(其中初治19例,复发22例,符合难治标准17例)及同期41例健康查体者为研究对象。所有标本均抽取清晨空腹外周血,以肝素钠抗凝。应用流式细胞术(FCM)测定ITP患者和健康对照外周血的CD4+CD25+调节性细胞及Th17细胞百分率;应用酶联免疫吸附试验(ELISA技术)测定ITP患者和健康对照血浆的IL-17水平。结果 ITP病例组外周血CD4+CD25+调节T细胞的百分率明显低于对照组(P<0.05),而Th17细胞的比例显著高于正常对照组(P<0.05),血浆IL-17水平在两组间差异无统计学意义(P>0.05);病例组中初治患者与复发患者外周血CD4+CD25+调节T细胞的百分率比较差异无统计学意义(P>0.05);难治组患者外周血CD4+CD25+调节T细胞的百分率低于非难治组(P<0.05);初治患者治疗后外周血CD4+CD25+调节T细胞百分率显著升高,但仍低于正常对照组(P<0.05)。ITP病例组的CD4+CD25+Treg/Th17较健康对照组明显下降,差异具有统计学意义(P<0.05)。结论特发性血小板减少性紫癜(ITP)患者外周血CD4+CD25+调节性T细胞显著减少,Th17细胞明显增加,出现Treg/Th17细胞失衡,这可能是影响特发性血小板减少性紫癜发生发展的一个重要因素。ITP患者外周血CD4+CD25+调节性T细胞减少程度在初治与复发ITP患者中差异无统计学意义;难治性ITP可能与CD4+CD25+调节性T细胞数量减少和Treg/Th17失衡尚未纠正有关。初治ITP患者经临床常规治疗后外周血CD4+CD25+调节性T细胞比例回升。更多还原

【Abstract】 Objective To further investigate and verify the expression of CD4+CD25+regulatory T cells and Th17 cells,and their roles in idiopathic thrombocytopenic purpura(ITP). Methods There were 41 ITP patients were enrolled by the diagnostic criteria for ITP.The control group consisted of 41 healthy person.All specimens were morning fasting peripheral blood.The percentage of CD4+CD25+regulatory T cells and Th17 cells in the peripheral blood from patients and controls were examined with flow cytometric.ELISA was used to detect the plasma level of IL-17.Results The percentage of CD4+CD25+regulatory T cells in the peripheral blood of ITP patients was lower than the normal controls(P<0.05),and significantly lower in refractory ITP patients,but there was no statistical difference between primary ITP patients and recurrent ITP patients(P>0.05).After treatment,the percentage of CD4+CD25+Treg cells in the peripheral blood of primary ITP patients was higher than before(P<0.05),but still lower than the normal controls(P<0.05).The percentage of Th17 cells in ITP patients was markedly higher than that of the normal controls(P<0.05).The plasma level of IL-17 was insignificantly changed between ITP patients and the normal controls(P>0.05).Treg/Th17 of ITP patients was significantly lower than the normal controls(P<0.05).Conclusion The reduction of CD4+CD25+Treg cells and the increase of Th17 cells do exist in the peripheral blood of ITP patients and lead to a loss of balance of Treg/Th17,that may play an important role in the pathogenesis and development of ITP.The degrees of CD4+CD25+Treg cells in the peripheral blood between the first-treated and relapsed ITP patients are not significant.Refractory ITP cases may be correlated with the low expression of CD4+CD25+Treg cells and the uncorrected imbalance of Treg/Th17.Clinical routine treatment could increase the CD4+CD25+Treg cells rate in the peripheral blood of ITP patients.更多还原