难治性免疫性血小板减少症患者调节性T细胞检测及其意义

Detection and Significance of Regulatory T Cells in Patients with Refractory Immune Thrombocytopenia

摘要: 目的：探索难治性免疫性血小板减少症患者外周血中调节性T细胞数量的变化，明确二者之间是否存在相关性。方法：采用流式细胞仪分别检测21例健康人，21例难治性ITP患者CD4⁺CD25⁺细胞和CD4⁺CD25⁺Foxp3⁺细胞的表达水平，将两组计量资料进行统计学分析。结果：难治性ITP患者中外周血CD4⁺CD25⁺细胞比例(4.52 ± 2.95)%、CD4⁺CD25⁺Foxp3⁺占CD4⁺细胞比例(2.30 ± 0.72)%，与正常对照组相比，均明显下降，差异具有统计学意义(P < 0.001, 0.05)，与血小板下降数量无相关性(P > 0.05)。结论：难治性ITP患者体内调节性T细胞数量下降，考虑体内存在自身反应亢进，可破坏血小板，但两者无相关性，这可能也是导致ITP难治的原因之一。

Abstract: Objective: To explore the expression of regulatory T cells in peripheral blood in patients with re-fractory immune thrombocytopenia (ITP) and the association between them. Methods: 21 patients with refractory ITP and 21 health controls were studied. The expressions of CD4⁺CD25⁺ cells and CD4⁺CD25⁺Foxp3⁺ cells were detected by flow cytometry. Statistical analysis was carried out with regard to data in two groups. Results: The ratios of CD4⁺CD25⁺ cells and CD4⁺CD25⁺Foxp3⁺ cells/ CD4+ cells in patients with refractory ITP decreased significantly compared with those in the con-trol group ((4.52 ± 2.95)% vs (6.33 ± 2.93)%, P < 0.001; (2.30 ± 0.72)% vs (4.17 ± 1.23)%, P < 0.05). There was no correlation between platelet counts and Treg cells. Conclusions: Detection of Treg cells in patients with refractory ITP can induce the hyper auto-reactive activation and more damages of platelets, but they don’t have relations, which may be one reason of refractory ITP.

文章引用：赖宗浪, 李冬云, 雷勇, 褚雨霆, 陈信义, 许亚梅. 难治性免疫性血小板减少症患者调节性T细胞检测及其意义[J]. 临床医学进展, 2014, 4(3): 42-46. http://dx.doi.org/10.12677/ACM.2014.43008

参考文献

[1]	Rodeghiero, F., Stasi, R., Gemsheimer, T., et al. (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: Report from an international working group. Blood, 113, 2386-2393.
[2]	赵湜, 王红祥, 李菁媛, 等 (2006) 调节性T细胞在慢性特发性血小板减少性紫癜中的作用. 中华血液学杂志, 3, 203-205.
[3]	Yu, J., Heck, S., Patel, V., et al. (2008) Defective circulating CD25 regulatory T cells in patients with chronic immune thrombocytopenic purpura. Blood, 112, 1325-1328.
[4]	郭守红, 石庆之, 华建媛, 等 (2010) 调节性T细胞和Th17细胞比值的变化与特发性血小板减少性紫癜发病关系的研究. 中华血液学杂志, 9, 610-612.
[5]	陈方平, 付斌 (2010) 难治性特发性血小板减少性紫癜规范化诊断和治疗. 临床血液学杂志, 7, 385-387.
[6]	沈权, 司今, 俞立权, 等 (2008) 特发性血小板减少紫癜者CD4+CD25+Treg细胞因子表达. 中国组织工程研究与临床康复, 25, 4895-4898.
[7]	Scabeni, S., Lapilla, M., Musio, S., et al. (2008) CD4+CD25+ regulatory T cells specific for a thymus-expressed antigen prevent the development of an anaphylaxis to self. The Journal of Immunology, 180, 4433-4440.
[8]	张爱梅, 徐修才, 王宁玲, 等 (2009) CD4+CD25+Treg在儿童急性免疫性血小板减少性紫癜发病机制中的作用.临床儿科杂志, 12, 1157-1161.
[9]	Antony, P.A. and Restifo, N.P. (2005) CD4+CD25+T regulatory cells, immunotherapy of cancer, and interleukin-2. The Journal of Immunology, 28, 120-128.
[10]	Lin, B., Zhao, H., Poon, M.C., et al. (2007) Abnormality of CD4+CD25+regulatory T cells in idiopathic thrombocytopenic purpura[J]. European Journal of Haematology, 78, 139-143.
[11]	Walters, S., Webster, K.E., Sutherlandm, A., Gardam, S., Groom, J., Liuwantara, D., et al. (2009) Increased CD4+FOXP3+ T cells in BAFF-transgenic mice suppress T cell effector responses. Journal of Immunology, 182, 793- 801.
[12]	罗祖军, 刘新海 (2009) 特发性血小板减少性紫癜患者调节性T细胞及Foxp3基因的检测. 实验与检验医学, 6, 589-590, 594.
[13]	伏瑞祥, 吴德沛 (2003) CD4+CD25+调控T细胞及其在移植耐受中的作用. 中国实验血液学杂志, 3, 321-324.
[14]	吕学文, 刘仿, 伍昌林 (2007) Foxp3基因表达与CD4+CD25+调节性T细胞在急性特发性血小板减少性紫癜发病中的作用. 实用儿科临床杂志, 3, 188-190.
[15]	陈信义, 李冬云, 许亚梅 (2011) 难治性免疫性血小板减少症中医治疗优势与临床实践. 中国中西医结合杂志, 8, 1033-1035.
[16]	许亚梅, 李冬云, 陈信义 (2006) 难治性血小板减少性紫癜中医治疗初探. 北京教育学院学报(自然科学版), 2, 19-20.