不同治疗方案对原发免疫性血小板减少症患者外周血调节性T细胞水平的影响  

Effect of different therapeutic regimens on regulatory T cells in patients of primary immune thrombo- cytopenia

作　　者：李振宇[1,2] 李德鹏 闫志凌[1,2] 邢伟伟[1,2] 刘凯歌 曹江[1,2] 何徐彭[1,2] 潘秀英[1,2] 徐开林[1,2] 

机构地区：[1]徐州医学院附属医院血液科,221002 [2]徐州医学院移植免疫实验室

出　　处：《中华血液学杂志》2013年第6期478-481,共4页Chinese Journal of Hematology

摘　　要：目的观察原发免疫性血小板减少症（ITP）患者治疗前后外周血调节性T细胞（Treg）水平变化，初步探讨Treg细胞在ITP发病中的作用。方法选取138例新诊断ITP患者，男57例、女81例，中位年龄40（18～70）岁。按治疗方案随机分为①泼尼松组（49例）：泼尼松1．5mg·kg^-1·d-1口服；②地塞米松组（45例）：地塞米松40mg／d第1—4天口服；③地塞米松＋小剂量利妥昔单抗组（44例）：地塞米松40mg／d第1～4天口服，利妥昔单抗100mg第7、14、21、28天静脉滴注。各组患者于治疗前、治疗后14d和28d分别采取外周静脉血，采用流式细胞术检测CD4＋CD25^highCD127low细胞（Treg）水平。以30名健康体检者为正常对照组。结果治疗后第28天，泼尼松组、地塞米松组、地塞米松＋小剂量利妥昔单抗组的总有效率分别为69．4％、66．7％、79．5％，差异无统计学意义；随访12个月，地塞米松＋小剂量利妥昔单抗组持续有效率（66．7％）高于泼尼松组（37．8％）和地塞米松组（22．7％），差异有统计学意义（P〈0．05），泼尼松与地塞米松组之间差异无统计学意义。138例ITP患者治疗前外周血CD4＋CD25highCD127low细胞表达水平低于健康对照组[（1．67±0．70）％对（4．02±0．39）％，P〈0．05]；地塞米松＋／J,N量利妥昔单抗组治疗后14、28dCD4＋CD25highCD127low细胞水平[（4．28±1．09）％、（4．44±0．63）％]均高于治疗前[（1．68±0．68）％]，差异有统计学意义（P值均〈0．05）；泼尼松组、地塞米松组患者治疗后14dCD4＋CD25highCD127low细胞水平均高于治疗前[（3．47±0．77）％对（1．69±0．73）％、（3．23±0．78）％对（1．70±0．75）％，P值均〈0．05]；治疗后28d，泼尼松组、地塞米松组患者CD4’CD25highCD127low细胞水平[（2．69±0．64）％、（2．59±0．67）％]与治疗前比较差异无统计学意义。结论新诊�Objective To investigate the change of CD4 ＋ CD25high CD127low regulatory T cells （Tregs） percentage in patients with primary immune thrombocytopenia （ITP） treated by different methods. Methods One hundred and thirty-eight newly diagnosed adult ITP patients （ 57 male, median age 40 years, range 18- 70 years） were enrolled in this study, who were randomisedly separated into three regiment groups, namely prednisolone （PSL,1.5 mg/kg for 2 -4 weeks and subsequently stepwise reduction） group enrolled 49 patients, dexamethasone [ （one course of high-dose dexamethasone （HDD） 40 mg/day, dl- 4 ] 45 patients, and rituximab plus HDD （rituximab 100 mg on days 7, 14, 21, 28 and HDD） group 44 pa- tients. Peripheral blood was taken in ITP patients of each group before treatment, 14d and 28d after treat- ment. The percentages of CD4 ＋ CD25hlghCD127l^w Tregs in 30 healthy controls and 138 patients were analyzed by flow cytometry. Results Overall response （OR） rates of PSL, HDD and R ＋ HDD groups at day 28 were 69.4% , 66.7% and 79.5% respectively with no difference. After the following 12 months, sustained re- sponse （SR） was more pronounced in R ＋ HDD group compared to the other two groups（ R ＋ HDD vs PSL： 66.7% vs 37.8%, P〈0.05; R ＋HDD vs HDD： 66.7%vs 22.7%, P 〈0.05）. The percentage of CD4＋ CD25high CD127low Tregs in peripheral blood of ITP patients [ （ 1.67±0.70） % ] was significantly lower than in healthy control group ; After treatment, the percentages of Tregs in peripheral blood of patients both at day 14 and 28 in R ＋ HDD group remarkably decreased compared with before treatment [ （4.28±1.09） % vs （1.68±0.68）%, P〈0.05; （4.44±0.63）% vs （1.68±0.68）% 1- The percentages of Tregs at day14 in both other two groups decreased notably compared with before treatment. But the Tregs levels measured at day 28 in PSL and HDD groups were similar with before treatment. Conclusion The percentage of CD4＋ ＋ CD25highCD127high Tregs in peripheral bloo

关 键 词：血小板减少症 免疫性 单克隆抗体 CD20 糖皮质激素 调节性T细胞 

分 类 号：R5[医药卫生—内科学]