糖皮质激素对ITP初治患者T辅助细胞相关细胞因子基因表达的影响  

Conventional Dose of Prednisone Regulates Th-associated Gene Expression in De Novo ITP Patients

作　　者：李锋[1] 吴擘颋[2] 王伟光[1] 詹延霞[1] 邹善华[1] 程韵枫[1] 

机构地区：[1]复旦大学附属中山医院血液科,上海200032 [2]复旦大学附属中山医院输血科,上海200032

出　　处：《中国实验血液学杂志》2011年第1期197-201,共5页Journal of Experimental Hematology

基　　金：国家自然科学基金(编号30972737);上海市科委浦江人才(编号09PJ1402500);教育部留学回国人员科研启动基金(第35批)

摘　　要：本研究旨在探讨免疫性血小板减少性紫癜(ITP)患者中T辅助细胞(helper T cell,Th)细胞免疫状态以及其与治疗反应的关系。应用实时荧光定量RT-PCR方法检测20例初发ITP患者(男性8例,女性12例,中位年龄41.0岁)接受糖皮质激素治疗[泼尼松1mg/(kg.d)]前后以及20例正常对照者外周血单个核细胞中Th细胞相关基因(T-bet、IFN-γ、GATA-3、TGF-β、Foxp3、IL-2、IL-4)表达水平的变化。结果表明:治疗前ITP患者外周血单个核细胞中T-bet、IFN-γ、IL-2表达较正常对照明显升高,差异有显著统计学意义(p<0.01),治疗后患者T-bet、IFN-γ、IL-2表达较治疗前降低(p<0.05);治疗前Foxp3表达较正常无明显变化,治疗后Foxp3表达较治疗前升高(p<0.05)。治疗前患者TGF-β的表达与正常对照相比无明显差别,治疗后老年患者与年轻患者中呈现不同的变化模式,年龄<60岁患者治疗后TGF-β表达水平较治疗前降低(p<0.05),而年龄≥60岁患者TGF-β较治疗前升高。结论:ITP患者存在Th细胞亚群失衡,常规糖皮质激素治疗仍是针对初治ITP患者的有效治疗手段,其作用机制可能与改善Th细胞亚群失衡有关。This study was aimed to investigate the T cell（helper T cells） immune status in ITP patients and its relation with therapeutic response.20 de novo ITP patients were enrolled（8 males,12 females） with a median age of 41（20 to 81）.Real-time RT-PCR method was used to measure the gene expression of Th cells including T-bet,IFN-γ,GATA-3,TGF-β,Foxp3,IL-2,IL-4 in PBMNC of ITP patients before and after conventional dose of prednisone therapy [1 mg/（kg·d）] and in PBMNC of 20 normal controls.The results showed that T-bet,IFN-γ and IL-2 were significantly over-expressed in PBMNC of ITP patients before treatment compared with that in normal controls（p0.01）,and compared with that before treatment,T-bet,IFN-γ,and IL-2 were markedly down-regulated in ITP patients after treatment.Before treatment,the expressions of Foxp3,TGF-β,GATA3 and IL-4 in ITP patients did not show difference from normal controls,while after treatment Foxp3 were more up-regulated than that before treatment（p0.05）.After treatment,TGF-β expression showed a different pattern between old and young patients.TGF-β expression was down-regulated（p0.05） among ITP patients younger than 60,while up-regulated in older patients.It is concluded that there is an imbalance of Th1/Th2/Treg cytokines in ITP patients,which can be reversed by glucocorticoid treatment.The conventional dose of glucocorticoid may be regarded as effective therapy for de novo ITP patients,it may correlate with improvement of imbalance between Th1/The2/Treg cytokines.

关 键 词：免疫性血小板减少性紫癜 TH细胞 发病机制 

分 类 号：R558.2[医药卫生—血液循环系统疾病]