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目的:探讨特发性血小板减少性紫癜(ITP)患者外周血淋巴细胞及血小板上CD 40、CD 40L和血浆sCD 40、sCD 40L的表达及意义。方法:采用免疫荧光标记和流式细胞术检测37例ITP患者和30例健康志愿者外周血CD 19+CD 40+细胞和CD 3+CD 40L+细胞分别占淋巴细胞的比例及血小板膜表面CD 40和CD 40L水平,采用EL ISA检测血浆sCD 40和sCD 40L水平。结果:与健康志愿者相比,急性ITP患者外周血CD 19+CD 40+细胞和CD 3+CD 40L+细胞均增多(P<0.05),血浆sCD 40水平显著降低(P<0.01),sCD 40L水平显著增高(P<0.01),血小板膜表面CD 40L表达增多(P<0.05),慢性ITP患者CD 3+CD 40L+细胞显著增多(P<0.01);与治疗前比较,急性ITP患者治疗缓解后血浆sCD 40水平显著增高(P<0.01),sCD 40L水平显著降低(P<0.01),CD 3+CD 40L+细胞及血小板膜CD 40L表达均降低。结论:ITP患者CD 40/CD 40L共刺激分子存在异常,可能与ITP发病密切相关,治疗缓解后CD 40/CD 40L恢复正常。
Objective: To investigate the expression and significance of CD40, CD40L, sCD40 and sCD40L on peripheral blood lymphocytes and platelets in patients with idiopathic thrombocytopenic purpura (ITP). Methods: The percentage of CD 19 + CD 40+ cells and CD 3 + CD 40L + cells in peripheral blood of 37 patients with ITP and 30 healthy volunteers were detected by immunofluorescence staining and flow cytometry respectively, and the ratio of CD 40 And CD40L levels, plasma levels of sCD40 and sCD40L were measured using EL ISA. Results: Compared with healthy volunteers, the levels of CD 19 + CD 40+ cells and CD 3 + CD 40L + cells in peripheral blood of patients with acute ITP increased (P <0.05) and the levels of plasma sCD 40 decreased significantly (P <0.01) (P <0.01). The expression of CD40L on platelet membrane surface was increased (P <0.05), and the level of CD3 + CD40L + cells in chronic ITP patients was significantly higher than that before treatment (P <0.01) Plasma sCD40 level was significantly increased (P <0.01), sCD40L level was significantly lower (P <0.01), CD3 + CD40L + cells and platelet membrane CD40L expression were lower. Conclusion: There is abnormal CD40 / CD40L costimulatory molecules in patients with ITP, which may be closely related to the onset of ITP. CD40 / CD40L returned to normal after treatment.