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目的检测急性免疫性血小板减少症(ITP)患儿T淋巴细胞亚群、NK细胞、其他相关细胞因子和血小板相关抗体,探讨急性ITP发病机制。方法 2011年4月至2012年2月新乡医学院第一附属医院儿科采用流式细胞仪检测32例急性ITP患儿及20例外科住院儿童(对照)外周血T细胞亚群、NK细胞比例,采用双抗体夹心酶联免疫吸附试验定量(ELISA)方法检测两组外周血血小板相关抗体(PAIgA、PAIgG、PAIgM)、γ干扰素(IFN-γ)、白细胞介素(IL)-4水平,并进行比较分析。结果急性ITP患儿CD3+、CD4+、CD4+/CD8+水平均明显低于对照组(P<0.05),CD8+水平明显高于对照组(P<0.05);急性ITP患儿NK细胞水平与对照组比较差异无统计学意义(P>0.05);急性ITP患儿PAIgG、PAIgA、PAIgM的水平均明显高于对照组(P<0.05);急性ITP患儿IFN-γ水平明显高于对照组(P<0.05),IL-4水平明显低于对照组(P<0.05)。急性ITP患儿CD4+、CD8+细胞百分比改变与血小板计数(BPC)无相关(P>0.05),IFN-γ与IL-4呈明显负相关(r=-0.907,P<0.05),PAIgG与BPC呈明显负相关(r=-0.846,P<0.05)。结论急性ITP患儿存在T细胞亚群失衡、体液免疫紊乱,同时存在细胞因子紊乱,可能是一种Th1优势疾病。T淋巴细胞亚群、细胞因子及血小板相关抗体的变化可较好地反映儿童急性ITP病理过程,NK细胞与儿童急性ITP发病机制关系尚不明确。
Objective To detect T lymphocyte subsets, NK cells, other related cytokines and platelet-associated antibodies in children with acute immune thrombocytopenia (ITP) and to explore the pathogenesis of acute ITP. Methods From April 2011 to February 2012, the pediatric department of the First Affiliated Hospital of Xinxiang Medical College used flow cytometry to detect T cell subsets and NK cell proportion in peripheral blood of 32 acute ITP children and 20 surgical in-hospital children (control) The levels of peripheral blood platelet-related antibodies (PAIgA, PAIgG, PAIgM), IFN-γ, IL-4 in the two groups were detected by ELISA. For comparative analysis. Results The levels of CD3 +, CD4 + and CD4 + / CD8 + in children with acute ITP were significantly lower than those in control group (P <0.05), while the levels of CD8 + in children with acute ITP were significantly higher than those in control group (P <0.05) The levels of PAIgG, PAIgA and PAIgM in children with acute ITP were significantly higher than those in control group (P <0.05). The levels of IFN-γ in children with acute ITP were significantly higher than those in control group (P <0.05) ), IL-4 levels were significantly lower than the control group (P <0.05). The percentage of CD4 + and CD8 + cells in acute ITP children had no correlation with platelet count (BPC) (P> 0.05), while negative correlation was found between IFN- γ and IL-4 (r = -0.907, P <0.05) Obviously negative correlation (r = -0.846, P <0.05). Conclusion There is an imbalance of T cell subsets and humoral immune disorders in children with acute ITP, and the presence of cytokine disorders may be a predominant Th1 disease. The changes of T lymphocyte subsets, cytokines and platelet-associated antibodies can well reflect the acute pathological process of ITP in children. The relationship between NK cells and the pathogenesis of acute ITP in children is not yet clear.