本文選題：原發(fā)免疫性血小板減少癥(ITP) + 淋巴細(xì)胞亞群��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過(guò)對(duì)成人原發(fā)免疫性血小板減少癥(ITP)患者外周血淋巴細(xì)胞亞群的分析,了解ITP的發(fā)病機(jī)制,以期運(yùn)用外周血淋巴細(xì)胞亞群檢測(cè)對(duì)成人原發(fā)免疫性血小板減少癥患者的臨床特征、預(yù)后及治療提供指導(dǎo)意義。[方法]收集昆明醫(yī)科大學(xué)第一附屬醫(yī)院血液內(nèi)科自2016年01月至2017年02月收治的原發(fā)免疫性血小板減少癥患者共計(jì)54例作為研究組,同時(shí)選擇49例健康體檢者作為對(duì)照組。對(duì)兩組的外周血淋巴細(xì)胞亞群絕對(duì)值進(jìn)行檢測(cè),應(yīng)用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析兩組間淋巴細(xì)胞亞群的差異,并且對(duì)這54例患者進(jìn)一步從病情嚴(yán)重程度、疾病狀態(tài)等方面進(jìn)行分層分析淋巴細(xì)胞亞群的差異,以期運(yùn)用外周血淋巴細(xì)胞亞群檢測(cè)對(duì)成人原發(fā)免疫性血小板減少癥患者的臨床特征、預(yù)后及治療提供指導(dǎo)意義。[結(jié)果]1.54例ITP患者與49例健康體檢者相比:CD3+總T淋巴細(xì)胞、CD3+CD4+T細(xì)胞、CD3-CD16+CD56+NK細(xì)胞減少、CD4+與CD8+T細(xì)胞的比值下降,CD3+CD8+T細(xì)胞、CD3-CD19+B淋巴細(xì)胞增多,且P0.05,差異均具有統(tǒng)計(jì)學(xué)意義;2.28例新診斷的患者、19例復(fù)發(fā)難治患者及健康對(duì)照組進(jìn)行各淋巴細(xì)胞亞群之間的兩兩對(duì)比,發(fā)現(xiàn)新診斷組較健康對(duì)照組同樣有CD3+總T淋巴細(xì)胞、CD3+CD4+T細(xì)胞、CD3-D16+D56+NK細(xì)胞減少、CD4+與CD8+T細(xì)胞的比值下降,CD3+CD8+T細(xì)胞、CD3-CD19+B淋巴細(xì)胞增多,且P0.05,差異均具有統(tǒng)計(jì)學(xué)意義;復(fù)發(fā)難治組較健康對(duì)照組也同樣有前各淋巴細(xì)胞亞群的變化特點(diǎn),但除了CD19+的B淋巴細(xì)胞具有統(tǒng)計(jì)學(xué)意義外,其余淋巴細(xì)胞亞群差異沒(méi)有統(tǒng)計(jì)學(xué)意義;新診斷組與復(fù)發(fā)難治組各淋巴細(xì)胞亞群之間比較,P0.05,各淋巴細(xì)胞亞群之間差異沒(méi)有統(tǒng)計(jì)學(xué)意義;3.重型ITP組、非重型ITP組及健康對(duì)照組之間各淋巴細(xì)胞亞群進(jìn)行兩兩比較,重型ITP、非重型ITP與健康對(duì)照相比都呈現(xiàn)CD3+T細(xì)胞、CD3+CD4+T細(xì)胞、CD4+與CD8+T細(xì)胞的比值、CD16+CD56+NK細(xì)胞絕對(duì)值下降,CD3+CD8+T細(xì)胞、CD19+B細(xì)胞絕對(duì)值上升,P值均0.05,差異有統(tǒng)計(jì)學(xué)意義;重型ITP組與非重型ITP組相比除CD19+B淋巴細(xì)胞外,其余各細(xì)胞亞群沒(méi)有統(tǒng)計(jì)學(xué)意義,且重型ITP組CD19+B淋巴細(xì)胞較非重型減少更明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);4.54例ITP患者治療前的血小板計(jì)數(shù)與對(duì)應(yīng)的CD19+的B淋巴細(xì)胞絕對(duì)值進(jìn)行相關(guān)性分析,ITP患者外周血CD19+B淋巴細(xì)胞絕對(duì)值與治療前血小板計(jì)數(shù)呈負(fù)相關(guān)(r=-0.274,P=0.045)。[結(jié)論]1.ITP發(fā)病涉及復(fù)雜的免疫學(xué)機(jī)制,總體特征表現(xiàn)為:CD3+總T淋巴細(xì)胞、CD3+CD4+T細(xì)胞、CD3-CD16+CD56+NK細(xì)胞減少、CD4+與CD8+T細(xì)胞的比值下降,CD3+CD8+T細(xì)胞、CD3-CD19+B淋巴細(xì)胞增多;2.目前國(guó)內(nèi)對(duì)于復(fù)發(fā)難治ITP及重癥ITP在免疫學(xué)的病因尚未闡明,我中心通過(guò)對(duì)復(fù)發(fā)難治ITP及重癥ITP患者淋巴細(xì)胞亞群的分析發(fā)現(xiàn),CD3-CD19+B淋巴細(xì)胞介導(dǎo)的體液免疫可能在其中發(fā)揮了重要的作用,這可能為臨床上復(fù)發(fā)難治及重癥ITP患者在治療選擇上提供思路。
[Abstract]:[objective] to understand the pathogenesis of ITP by analyzing the lymphocyte subsets in peripheral blood of adult patients with primary immune thrombocytopenia. The purpose of this study was to provide guidance for clinical features, prognosis and treatment of adult primary immune thrombocytopenia by using peripheral blood lymphocyte subsets. [methods] A total of 54 patients with primary immune thrombocytopenia from January 2016 to February 2017 in Department of Hematology, first affiliated Hospital of Kunming Medical University were collected as study group and 49 healthy persons as control group. The absolute value of lymphocyte subsets in peripheral blood of the two groups was detected, and the difference of lymphocyte subsets between the two groups was statistically analyzed by SPSS21.0 software, and the severity of the disease was further analyzed in 54 patients. In order to provide guidance for clinical features, prognosis and treatment of adult patients with primary immune thrombocytopenia, the difference of lymphocyte subsets in peripheral blood was analyzed in this paper. [results] 1.Compared with 49 healthy controls, 54 patients with ITP had increased CD3-CD19 B lymphocytes, CD3-CD16 CD56 NK cells and CD3-CD16 CD56 NK cells decreased the ratio of CD 4 to CD8 T cells. The difference of P0.05 was statistically significant in 2.28 newly diagnosed patients, 19 relapsed and refractory patients and healthy control group were compared with each other among lymphocyte subsets. It was found that in the newly diagnosed group, CD3 total T lymphocytes, CD3 CD4 T cells and CD3-D16D56 NK cells decreased the ratio of CD 4 to CD8 T cells, and CD3 CD8 T cells CD3-CD19 B lymphocytes increased, and the difference was statistically significant (P 0.05). The former lymphocyte subsets in the relapsing refractory group were similar to those in the healthy control group, but there was no significant difference in the other lymphocyte subsets except the B lymphocyte of CD19. There was no significant difference in lymphocyte subsets between the newly diagnosed group and the relapsed refractory group (P 0.05). The lymphocyte subsets of severe ITP group, non-severe ITP group and healthy control group were compared in pairs. The ratio of CD3 T cells to CD3 CD4 T cells CD4 / CD8 T cells decreased the absolute value of CD16 CD56 NK cells increased significantly (P < 0.05). There was no significant difference in the subsets of all the cell subsets except CD19 B lymphocytes between the severe ITP group and the non-severe ITP group, and the decrease of CD19 B lymphocytes in the severe ITP group was more significant than that in the non-severe ITP group. There was a significant difference between the platelet count before treatment and the absolute value of B lymphocytes in the corresponding CD19 in 54 patients with ITP. There was a negative correlation between the absolute value of CD19 B lymphocytes in peripheral blood and the platelet count before treatment in patients with ITP, and there was a negative correlation between the absolute value of CD19 B lymphocytes in peripheral blood and the platelet count before treatment. [conclusion] the pathogenesis of 1.ITP is involved in complicated immunological mechanism, and the overall characteristic is that CD3 CD4 T cells, CD3-CD16 CD56 NK cells decrease the ratio of CD 4 to CD8 T cells, and CD3 CD8 T cells increase CD3-CD19 B lymphocytes. At present, the etiology of relapsing refractory ITP and severe ITP in immunology has not been clarified. Through the analysis of lymphocyte subsets in patients with relapsing and refractory ITP and severe ITP patients, we found that the humoral immunity mediated by CD3-CD19B lymphocytes may play an important role in it. This may provide ideas for the treatment choice of patients with relapsing and refractory and severe ITP.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R558.2

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