本文選題：再生障礙性貧血 + IL-27�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的再生障礙性貧血(aplastic anemia,AA)是一種免疫介導(dǎo)的疾病。IL-27是參與自身免疫性疾病發(fā)病的重要細(xì)胞因子,可調(diào)控T淋巴細(xì)胞分化。目前IL-27在AA發(fā)病中的作用尚不清楚。因此,本研究通過(guò)檢測(cè)兒童再障患者血清IL-27、IFN-γ及IL-17的表達(dá),分析其血清IL-27水平與IFN-γ、IL-17水平、病情嚴(yán)重程度及免疫抑制治療療效之間的關(guān)系,進(jìn)而初步探討IL-27在兒童AA發(fā)病機(jī)制中的作用及臨床價(jià)值。方法病例組選取2015年12月至2016年12月鄭州大學(xué)第一附屬醫(yī)院兒科門診及住院治療的初診再障患兒(診斷標(biāo)準(zhǔn)參照中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)血液學(xué)組2014年制定的《兒童獲得性再生障礙性貧血診療建議》)。共收集AA患兒60例,其中非重型AA(non-severe aplastic anemia,NSAA)組40例,重型AA(severe aplastic anemia,SAA)組20例。同期于我院體檢的正常兒童25例為對(duì)照組。50例患兒接受免疫抑制治療,治療6個(gè)月評(píng)價(jià)療效。8例患兒觀察時(shí)間未到,無(wú)法評(píng)價(jià)療效,余患兒根據(jù)療效標(biāo)準(zhǔn)進(jìn)一步分為緩解組24例和未緩解組18例。排除患有先天性AA、腫瘤性疾病、骨髓增生異常綜合征、陣發(fā)性睡眠性血紅蛋白尿癥、肝臟疾病、營(yíng)養(yǎng)性貧血、病毒感染、結(jié)締組織病等及曾接受免疫抑制治療者。采用ELISA法檢測(cè)60例AA患兒治療前和25例健康對(duì)照者血清IL-27、IFN-γ、IL-17水平。實(shí)驗(yàn)數(shù)據(jù)采用SPSS21.0軟件處理。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差()或中位數(shù)(下四分位數(shù),上四分位數(shù))[M(P25,P75)]表示,兩組間定量資料比較采用t檢驗(yàn)或Wilcoxon秩和檢驗(yàn),多組間定量資料比較采用單因素方差分析(one-way ANOVA)或Kruskal-Wallis秩和檢驗(yàn),組間兩兩比較采用LSD-t檢驗(yàn)。定性資料比較用χ2檢驗(yàn),相關(guān)分析用Pearson檢驗(yàn)。檢驗(yàn)水準(zhǔn)α=0.05。結(jié)果1.SAA組及NSAA組血清IL-27水平分別為(169.98±34.91)pg/ml、(143.52±37.76)pg/ml,顯著高于健康對(duì)照組(45.67±24.99)pg/ml(P0.001),SAA組血清IL-27水平較NSAA組顯著升高(P0.05)。2.SAA組及NSAA組血清IFN-γ水平分別為(48.40±17.36)pg/ml、(37.87±14.79)pg/ml,較健康對(duì)照組顯著升高(25.82±12.64)pg/ml(P0.05),SAA組血清IFN-γ水平顯著高于NSAA組(P0.05)。AA患者血清IL-27與IFN-γ水平呈正相關(guān)(SAA:r=0.658,P=0.002;NSAA:r=0.461,P=0.003)。3.SAA組及NSAA組血清IL-17水平分別為(225.65±31.87)pg/ml、(198.37±42.66)pg/ml,顯著高于健康對(duì)照組(79.37±51.70)pg/ml(P0.001),SAA組血清IL-17水平較NSAA組顯著升高(P0.05)。AA患者血清IL-27與IL-17水平無(wú)相關(guān)性(SAA:P=0.302;NSAA:P=0.350)。4.免疫抑制治療緩解組血清IL-27水平低于未緩解組(157.96±28.06 vs171.83±26.84),但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.IL-27、IFN-γ和IL-17可能參與兒童AA的發(fā)病機(jī)制,血清IL-27、IFN-γ、IL-17水平與病情嚴(yán)重程度有關(guān),可能有助于再障的病情判斷。2.AA患兒血清IL-27水平與免疫抑制治療療效無(wú)關(guān)。
[Abstract]:Objective Aplastic aplastic anemiaa( AAA) is an immune-mediated disease. IL-27 is an important cytokine involved in the pathogenesis of autoimmune diseases and can regulate the differentiation of T lymphocytes. The role of IL-27 in the pathogenesis of AA is unclear. Therefore, by detecting the expression of serum IL-27, IFN- 緯 and IL-17 in children with aplastic anemia, the relationship between the level of serum IL-27 and the level of IFN- 緯 -IL-17, the severity of illness and the efficacy of immunosuppressive therapy was analyzed. The role and clinical value of IL-27 in the pathogenesis of AA in children were discussed. Methods from December 2015 to December 2016, children with aplastic anemia were selected from paediatrics outpatient and inpatient treatment of the first affiliated Hospital of Zhengzhou University. The diagnostic criteria were compared with those of the hematology group of the Chinese Academy of Pediatrics in 2014. Advice on diagnosis and treatment of childhood acquired aplastic anemia. A total of 60 cases of AA were collected, including 40 cases of non-severe AA(non-severe aplastic anemiahe group and 20 cases of severe AA(severe aplastic anemia group. At the same time, 25 normal children in our hospital were treated with immunosuppressive therapy in the control group of 50 cases. The curative effect of 8 cases was not observed for 6 months, and the curative effect could not be evaluated. According to the criteria of curative effect, Yu children were further divided into remission group (n = 24) and non-remission group (n = 18). Exclusion of congenital AAs, tumor diseases, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria, liver disease, nutritional anemia, viral infection, connective tissue disease, and previous immunosuppressive therapy. Serum IL-27 IFN- 緯 -17 levels were measured by ELISA in 60 patients with AA before treatment and 25 healthy controls. The experimental data are processed by SPSS21.0 software. The measurement data were expressed as mean 鹵standard deviation) or median (lower quartile, upper quartile) [MNP25P75]. The quantitative data between the two groups were compared by t test or Wilcoxon rank sum test. Single factor ANOVA (one-way ANOVA) or Kruskal-Wallis rank sum test were used to compare the quantitative data between groups and LSD-t test was used to compare the quantitative data between groups. The qualitative data were compared by 蠂 2 test and correlation analysis by Pearson test. The test level is 偽 0. 05. Results the serum IL-27 levels in 1.SAA group and NSAA group were 143.52 鹵37.76 ng / ml, respectively, which were significantly higher than those in NSAA group (45.67 鹵24.99pg / ml) and NSAA group (48.40 鹵17.36pgml / ml, 37.87 鹵79pgr / ml, respectively). The serum IFN- 緯 levels in SAA group were significantly higher than those in NSAA group (25.82 鹵12.64pgml / ml) and the serum IFN- 緯 level in NSAA group (P < 0.05) was significantly higher than that in control group (P < 0.05 / ml), respectively. The level of serum IFN- 緯 in SAA group was significantly higher than that in NSAA group (P < 0.05). The level of serum IFN- 緯 in SAA group and NSAA group was 48.40 鹵17.36 mg / ml and 25.82 鹵12.64pgml / g / ml respectively. 鏄捐憲楂樹(shù)簬NSAA緇，

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