本文選題：調(diào)節(jié)性B細(xì)胞 + 免疫性血小板減少癥��； 參考：《濟(jì)寧醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過(guò)檢測(cè)免疫性血小板減少癥疾病患者及健康者外周血中CD19+CD24hiCD38hi調(diào)節(jié)性B細(xì)胞的水平及其功能的變化,探討調(diào)節(jié)性B細(xì)胞在ITP疾病的發(fā)生、出血風(fēng)險(xiǎn)、發(fā)展、轉(zhuǎn)歸及預(yù)后中所起的作用,深入研究調(diào)節(jié)性B細(xì)胞與ITP發(fā)病機(jī)理的關(guān)系。方法:選取2015年01月01日至2016年12月31日于濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院血液科門診就診或住院的免疫性血小板減少癥(Immune thrombocytopenia,ITP)患者124例作為實(shí)驗(yàn)組;選取同期年齡、性別匹配的37例健康人群作為對(duì)照組。并根據(jù)ITP的分型及分期標(biāo)準(zhǔn),將ITP患者分為四個(gè)不同的組別:新診斷的ITP組、持續(xù)性ITP組、慢性ITP組和重癥ITP組。根據(jù)療效標(biāo)準(zhǔn)將完全緩解組,分別比較激素治療前后,及其與持續(xù)性ITP組、慢性ITP組及重癥ITP組進(jìn)行比較。采用流式細(xì)胞學(xué)檢測(cè)研究對(duì)象外周血中的CD19+CD24hiCD38hi調(diào)節(jié)性B細(xì)胞(Regulatory B cells,Bregs)及其功能分子白介素-10(interleukin-10,IL-10)的水平,比較它們?cè)贗TP組和健康對(duì)照組的水平差異,以及在ITP各亞組之間的水平差異;采用原發(fā)免疫性血小板減少癥出血評(píng)分系統(tǒng)對(duì)ITP組進(jìn)行評(píng)分;所有受試對(duì)象進(jìn)行血常規(guī)、骨髓穿刺等指標(biāo)的檢測(cè)。選取一般人口學(xué)資料、血小板計(jì)數(shù)、出血評(píng)分作為參數(shù),通過(guò)相關(guān)分析,初步探討影響B(tài)regs功數(shù)量和功能的可能影響因素及其意義。結(jié)果:免疫性血小板減少癥患者外周血中的Bregs的水平(2.7519%±1.71625%)顯著低于對(duì)照組(8.3195%±0.98072%)(P0.05),且IL-10的水平(2.5059%±1.55297%)亦均低于健康組(7.0257%±0.78238%)(P0.05)。且在研究的ITP各亞組中,Bregs及其功能分子IL-10在持續(xù)性、慢性、重癥ITP組的人群中水平表達(dá)更低。但是,在完全緩解組中,Bregs的水平較治療前有明顯升高(P0.05),且比ITP其他亞組表達(dá)顯著增加(P0.05)。另外,通過(guò)相關(guān)分析發(fā)現(xiàn):Bregs與外周血PLT的水平(r=0.829,p0.05)、與ITP疾病的嚴(yán)重程度(r=0.434,p0.05)呈顯著正相關(guān),與ITP出血評(píng)分呈負(fù)相關(guān)(r=-0.771,p0.05);Bregs功能分子IL-10與外周血PLT的水平(r=0.742,p0.05)、與ITP疾病的嚴(yán)重程度(r=0.358,p0.05)呈顯著正相關(guān),與ITP出血評(píng)分呈負(fù)相關(guān)(r=-0.668,p0.05)。結(jié)論:調(diào)節(jié)性B細(xì)胞可能參與了免疫性血小板減少癥的發(fā)生以及發(fā)展,且與免疫性血小板減少癥疾病的嚴(yán)重程度明顯相關(guān),其可作為評(píng)估ITP的嚴(yán)重程度、疾病分型、出血風(fēng)險(xiǎn)的一個(gè)參考指標(biāo),也可作為評(píng)估診斷療效、疾病轉(zhuǎn)歸及預(yù)后的十分有效的一個(gè)指標(biāo)。調(diào)節(jié)性B細(xì)胞可作為難治性ITP患者免疫治療的新靶點(diǎn)。
[Abstract]:Objective: to detect the level and function of CD19 CD24hiCD38hi regulatory B cells in peripheral blood of patients with immune thrombocytopenia and healthy subjects, and to explore the occurrence, bleeding risk and development of regulatory B cells in ITP disease. To study the relationship between regulatory B cells and the pathogenesis of ITP. Methods: 124 patients with immune thrombocytopenia were selected as experimental group from January 01, 2015 to December 31, 2016 in the Department of Hematology, affiliated Hospital of Jining Medical College. Sex matched 37 healthy people as control group. According to the classification and staging of ITP, the patients with ITP were divided into four groups: newly diagnosed ITP group, persistent ITP group, chronic ITP group and severe ITP group. According to the therapeutic criteria, complete remission group was compared with persistent ITP group, chronic ITP group and severe ITP group before and after hormone therapy. Flow cytometry was used to detect the levels of CD19 CD24hiCD38hi regulatory B cells in peripheral blood and its functional molecule interleukin-10 (IL-10) in peripheral blood, and to compare their levels in ITP group and healthy control group, as well as among ITP subgroups. The primary immune thrombocytopenia haemorrhage scoring system was used to evaluate the ITP group, and all subjects were tested for blood routine examination and bone marrow puncture. The general demographic data, platelet count and bleeding score were selected as parameters. By correlation analysis, the possible influencing factors and their significance of Bregs work quantity and function were preliminarily discussed. Results: the level of Bregs in peripheral blood of the patients with immunological thrombocytopenia was 2.7519% 鹵1.71625), which was significantly lower than that of the control group (8.3195% 鹵0.98072), and the level of IL-10 was 2.50% 鹵1.552977%, which was also lower than that of the healthy group (7.02577% 鹵0.78238P 0.05). The expression of Bregs and its functional molecule IL-10 in the subgroups of ITP was lower in the persistent chronic and severe ITP groups. However, the level of Bregs in complete remission group was significantly higher than that before treatment, and the expression of Bregs was significantly higher than that of other subgroups of ITP. In addition, by correlation analysis, it was found that there was a significant positive correlation between the level of PLT in peripheral blood and the level of Bregs in peripheral blood, 0.829, p0.05a, and the severity of ITP disease, 0.434 (p0.05). There was a negative correlation between IL-10 and the level of PLT in peripheral blood, and a significant positive correlation with the severity of ITP disease, and a negative correlation with the score of ITP hemorrhage. Conclusion: regulatory B cells may be involved in the occurrence and development of immune thrombocytopenia, and may be associated with the severity of immune thrombocytopenia. It can be used to evaluate the severity and classification of ITP. A reference indicator for the risk of bleeding can also be used as a very effective indicator for evaluating the efficacy, outcome and prognosis of the disease. Regulatory B cells may be a new target for immunotherapy in patients with refractory ITP.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【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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