【摘要】：目的:檢測急性原發(fā)性免疫性血小板減少癥(acute primary immune thrombocytopenia,AITP)、慢性原發(fā)性免疫性血小板減少癥(chronic primary immune thrombocytopenia,CITP)患兒外周血CD4~+CD25~+CD127~-調(diào)節(jié)性T細(xì)胞(regulation T cell,Treg細(xì)胞)、轉(zhuǎn)化生長因子(transforming growth factorβ1,TGF-β1)、白介素(interleukin,IL-10)的含量,討論三者在ITP發(fā)生與發(fā)展中的作用機(jī)理。方法:入選符合ITP診斷標(biāo)準(zhǔn)的2015年1月至2016年6月期間在山西省兒童醫(yī)院血液科住院和門診診治的ITP患兒66例,根據(jù)病程分為AITP組、CITP組,AITP組為初診的未使用人免疫球蛋白及激素治療的ITP患兒35例,CITP組為病程大于12個(gè)月的ITP患兒31例,依據(jù)病情將初診的35例AITP患兒分為重型ITP組11例和非重型ITP組24例,正常對照組為本院2016年1月至3月體檢中心健康兒童20例。用流式細(xì)胞術(shù)(FCM)分別檢測AITP組、CITP組、重型ITP組、非重型ITP組及健康對照兒童外周血CD4~+CD25~+CD127~-百分率及血清IL-10含量,血清中TGF-β1含量用ELISA方法測得,并進(jìn)行各組間比較及相關(guān)性分析。結(jié)果:1.定量檢測表明,急性組CD4~+CD25~+CD127~-Treg百分率(4.23±0.82)%顯著低于對照組(5.05±0.90)%(P0.01),慢性組CD4~+CD25~+CD127~-Treg百分率(3.47±0.63)%顯著低于急性組(4.23±0.82)%(P0.01)。急性組TGF-β1水平(189.36±66.71)Pg?ml-1低于對照組(231.45±113.89)Pg?ml-1(P0.05),急性組IL-10含量(34.07±11.57)Pg?ml-1低于對照組(43.83±10.96)Pg?ml-1(P0.05),TGF-β1及IL-10含量慢性組低于急性組(P0.01)。非重型ITP組CD4~+CD25~+CD127~-Treg百分率(4.55±0.90)%顯著高于重型ITP組(4.14±0.58)%(P0.05),非重型ITP組TGF-β1水平(210.25±73.65)Pg?ml-1未明顯高于重型ITP組(188.16±57.7)Pg?ml-1(P0.05),非重型ITP組IL-10含量(39.42±13.55)Pg?ml-1未明顯高于重型ITP組(31.63±9.9)Pg?ml-1(P0.05)。2.相關(guān)性分析顯示,ITP患兒CD4~+CD25~+CD127~-Treg百分率與TGF-β1含量呈正相關(guān)(r=0.75,P0.01)。ITP患兒外周血IL-10含量與CD4~+CD25~+CD127~-Treg百分率、TGF-β1含量則無相關(guān)性。結(jié)論:ITP患兒外周血Treg數(shù)目下降以及TGF-β1、IL-10含量降低可能與ITP患兒的細(xì)胞免疫調(diào)節(jié)功能紊亂相關(guān),與調(diào)節(jié)性T細(xì)胞有關(guān)的免疫功能的改變在慢性組及重型ITP組中表現(xiàn)尤其明顯,這可能是慢性ITP患兒在疾病過程中治療效果不佳呈現(xiàn)長病程的原因之一。
[Abstract]:Objective: to detect the (regulation T cell,Treg cells of CD4~ CD25~ CD127~- regulatory T cells in peripheral blood of children with acute idiopathic thrombocytopenia (acute primary immune thrombocytopenia,AITP) and chronic idiopathic immune thrombocytopenia (chronic primary immune thrombocytopenia,CITP), transforming growth factor (transforming growth factor 尾 1 (TGF- 尾 1). The content of interleukin (interleukin,IL-10), The action mechanism of the three factors in the occurrence and development of ITP is discussed. Methods: 66 patients with ITP who met the diagnostic criteria of ITP in the Department of Hematology of Shanxi Children's Hospital from January 2015 to June 2016 were enrolled in this study. According to the course of disease, the patients were divided into three groups: AITP group, CITP group and AITP group. 35 cases of ITP were not treated with human immunoglobulin and hormone, and 31 cases of CITP group were ITP patients whose course of disease was longer than 12 months. According to the condition, 35 children with AITP were divided into severe ITP group (n = 11) and non-severe ITP group (n = 24). The normal control group consisted of 20 healthy children from January to March 2016. The percentage of CD4~ CD25~ CD127~- in peripheral blood and the content of IL-10 in serum of children in AITP group, CITP group, severe ITP group, non-severe ITP group and healthy control group were measured by flow cytometry (FCM). The TGF- 尾 1 content in serum was measured by ELISA method. The result is 1: 1. Quantitative analysis showed that the percentage of CD4~ CD25~ CD127~-Treg in acute group (4.23 鹵0.82)% was significantly lower than that in control group (5.05 鹵0.90)% (P0.01), and the percentage of CD4~ CD25~ CD127~-Treg in chronic group (3.47 鹵0.63)% was significantly lower than that in acute group (4.23 鹵0.82)% (P0.01). The level of TGF- 尾 1 in acute group (189.36 鹵66.71) Pg?ml-1 was lower than that in control group (231.45 鹵113.89) Pg?ml-1 (P0.05), IL-10 content in acute group (34.07 鹵11.57) Pg?ml-1 was lower than that in control group (43.83 鹵10.96) Pg?ml-1 (P0.05), TGF- 尾 1 and IL-10 content in chronic group was lower than that in acute group (P0.01). The percentage of CD4~ CD25~ CD127~-Treg in non-severe ITP group (4.55 鹵0.90)% was significantly higher than that in severe ITP group (4.14 鹵0.58)% (P0.05). The level of TGF- 尾 _ 1 in non-severe ITP group (210.25 鹵73.65) was not significantly higher than that in severe ITP group (188.16 鹵57.7) Pg?ml-1 (P0.05). IL-10 content in non-severe ITP group was (39.42 鹵13.55) Pg?ml-1 was not significantly higher than that in severe ITP group (31.63 鹵9.9) Pg?ml-1 (P0.05). Correlation analysis showed that there was a positive correlation between the percentage of CD4~ CD25~ CD127~-Treg and the content of TGF- 尾 _ 1 in children with ITP (r = 0.75 鹵P0.01), but there was no correlation between the percentage of IL-10 and the percentage of CD4~ CD25~ CD127~-Treg in peripheral blood of children with). ITP, while the content of TGF- 尾 _ 1 was not. Conclusion: the decrease of Treg in peripheral blood and the decrease of TGF- 尾 1 IL-10 in peripheral blood of ITP children may be related to the disorder of cellular immune regulatory function in ITP children, especially in chronic and severe ITP groups. This may be one of the reasons for the long course of treatment in children with chronic ITP.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R725.5

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