【作者】 张国栋；

【导师】 闵捷； 许洪志；

【作者基本信息】 山东大学 ， 内科学， 2007， 硕士

【摘要】 【目的】特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura，ITP)是一组与自身免疫相关的疾病，其发病既与体液免疫相关，还与细胞免疫相关，胸腺肽是一种具有生物活性的多肽，具有双向免疫调节作用，调控机体的免疫平衡。本文用大剂量胸腺肽联合常规剂量糖皮质激素治疗ITP，观察各组的临床疗效并比较治疗前后血小板相关抗体IgG、IgM、IgA、相关补体C3、淋巴细胞亚群CD3、CD4、CD8、CD4／CD8、NK细胞活性等免疫指标的变化。初步探讨胸腺肽在治疗ITP中的作用。【材料与方法】选择2006年3月至2006年11月在我院门诊、住院治疗的ITP患者60例作为研究对象，将60例患者随机分为治疗组和对照组，每组30例病例，治疗组在给予强的松1mg／(kg.d)治疗的同时，给予胸腺肽200mg／d静滴，对照组仅给予强的松1mg／(kg.d)治疗。观察各组的临床疗效并比较治疗前后血小板相关抗体IgG、IgM、IgA、补体C3、淋巴细胞亚群CD3、CD4、CD8、CD4／CD8、NK细胞活性的变化。血小板相关抗体PAIgG、PAIgA、PAIgM的检测用ELISA双抗体夹心法，血小板相关补体C3的测定用放射免疫竞争法，淋巴细胞亚群CD3、CD4、CD8、NK细胞的检测用流式细胞术。选择同时期的健康查体者20例作为正常对照组，同样方法检测上述各项指标。【结果】治疗组有效率为86.7％，激素对照组有效率为53.3％。治疗组治疗后与治疗前相比PAIgG、PAIgA、PAIgM明显降低，PAC3明显升高，差异有显著性(P＜0.05)。激素对照组治疗后与治疗前相比PAIgG、PAIgA、PAIgM、明显降低，PAC3明显升高，差异有显著性(P＜0.05)。治疗后治疗组与激素对照组比较PAIgG、PAIgA、PAIgM差异有显著性(P＜0.05)。两组治疗后CD3、CD4、CD4／CD8、NK细胞活性均明显高于治疗前，CD8低于治疗前，治疗组治疗前后T淋巴细胞亚群比较有显著性差异(P＜0.01)。激素对照组治疗前后T淋巴细胞亚群比较有显著性差异(P＜0.01)。治疗后治疗组与激素对照组T淋巴细胞亚群比较有显著性差异(P＜0.01)。【结论】ITP患者淋巴细胞亚群(CD3、CD4、CD4／CD8)、NK细胞活性均降低，治疗有效后上升，CD8、血小板相关抗体均升高，治疗有效后下降，相关补体治疗前明显降低，治疗后上升。胸腺肽联合糖皮质激素治疗比单纯应用糖皮质激素治疗疗效更高，上述各检测项目的变化更明显。胸腺肽可调节T淋巴细胞功能，间接调节B淋巴细胞功能，提高ITP的疗效，无明显副反应，配合常规方法治疗ITP是一种安全有效的方法。更多还原

【Abstract】 Objectiveldiopathic thrombocytopenic purpura (ITP) is a kind of immune-associated disease. It’s not only relevant to humoral immunity, and also cell immunity. Thymoxine has many bioactivities, it has two-way immunological regulation effect, and it can regulate the immunologic balance. We treat ITP with high dose thymoxine plus prednisone or only prednisone, evaluate the clinical implications and the change on immunological criteria of ITP before and after the treatment. And evaluate the value of using thymoxine to treat ITP.Materials and Methods To select 60 patients with ITP of receiving hospitalization and 20 healthy person from March 2006 to November 2006 in shandong provincial hospital. To divide 60 patients into 2 groups: The therapeutic group of 30 cases accepted high dose thymoxine(200mg per day, given by intravenous drips) and prednisone (1mg/kg per day), while the controlled group of 30 cases only prednisone (1mg/kg per day), to observe the clinical implications and the change of platelet associated immuno-globulin (PAIgG、PAIgM、PAIgA) with double-antibody-sandwich、platelet associated Complement(PAC3) with radioimmunodifrusion、lymphocyte subsets(CD3、CD4、CD8、CD4/CD8) and the cytoactive of NK cell with flow cytometry before and after the treatment. And detect these immunological criteria of the 20 healthy person.Results The effective rates of the therapeutic group and control group were 86.7% and 53.3% respectively, the CD3、CD4 positive cell percentages, CD4/CD8 ratio value, NK cell activities and PAIgG、PAIgA、PAIgM levels of the therapeutic group were all elevated in comparison to those before the treatment as well as the control group. PAC3、CD8 positive cell percentages were significantly lower than before treatment and the control group. The control group also has the same change before and after treat- ment, but not as significant as the therapeutic group.Conclusions The CD3、CD4、CD4/CD8、NK cell cytoactive were all lower, and the CD8、PAIgG、PAIgM、PAIgA were higher ,PAC3 lower in ITP patients, thease indication were amelioration after treament, and the therapeutic effect of the therapeutic group was better than the control group. The thymoxine can regulate the functions of T lymphocytes and also the functions of B-lymphocytes indirectly, it can improve the therapeutic efficacy of ITP.更多还原