伴自身抗体阳性的原发免疫性血小板减少症患者的骨髓形态学特征  

The immune characteristics in primary immune thrombocytopenia patients with abnormal auto-antibodies

作　　者：周红琳 陈以娟[1] 蔡欣[1] 任潇潇 郭慧霞[1] 张晶晶[1] 王立茹[1] ZHOU Honglin, CHEN Yijuan, GUO Huixia, ZHANG Jingjing, CUI Jianying, REN Xiaoxiao, WU Yue, WANG Liru.(FU Xing Hospital, Capital Medical University, Beijing 100038, Chin)

机构地区：[1]首都医科大学附属复兴医院血液科,北京100038

出　　处：《实用医学杂志》2018年第5期778-781,共4页The Journal of Practical Medicine

基　　金：北京市卫生系统高层次卫生技术人才培养计划市级基金(编号:2013-3-097)

摘　　要：目的通过分析免疫性血小板减少症(ITP)患者的骨髓细胞学及骨髓活检病理结果,探讨伴自身抗体阳性的原发ITP(PITP-ANA)患者的骨髓形态学变化规律。方法本研究纳入了首都医科大学附属复兴医院自2001年1月至2015年7月住院治疗110例ITP患者的临床资料,依据患者的免疫学检查,分为伴自身抗体阳性的原发ITP(PITP-ANA)组、原发ITP(PITP)组、自身免疫性疾病继发ITP(SITP)组,并回顾性分析各组患者骨髓形态学及病理特点。结果骨髓增生程度在3组患者中均以增生活跃及明显活跃为主。骨髓巨核细胞减少比例在PITP组、PITP-ANA组及SITP组分别为4.92%、16.67%、26.32%,SITP组巨核细胞数量较PITP组显著减少,差异有统计学意义。幼稚巨核细胞数量在SITP组高于PITP-ANA组。骨髓病理检查中网状纤维PITP-ANA组较其他两组增生明显。结论 SITP和PITP-ANA组患者的骨髓更易表现为巨核细胞计数减少和骨髓纤维化。Objective To investigate the immune status characteristics of primary ITP patients with abnormal auto-antibodies. Methods A total of 110 patients were enrolled in our study, who were admitted in Fu-Xing Hospital affiliated to Capital Medical University from January 2001 to July 2015. According to whether the patients have autoimmune diseases and the presence of auto-antibodies, we divided the patients into 3 groups, including the primary ITP with abnormal auto-antibodies （PITP-ANA） group, the primary ITP （PITP） group and the second- ary ITP （SITP） group. We compared the T-cell subsets, regulatory T cells, B lymphocytes, changes of immunoglob- ulin and bone marrow biopsy and cytology of patients among the three groups, retrospectively. Results The per- centage of CD3＋T cells （61.72 ± 10.60）% in PITP-ANA group was lower than that in PITP group （69.57 ± 11.99） %. The percentage of CD8＋T lymphocyte （24.00± 7.67 ）% was significantly lower than that of PITP group （30.59 ± 11.08）%（P 〈 0.05）. The proportion of Treg in PITP group, PITP-ANA group and SITP group were（6.12 ± 1.41 ）%, （7.50± 2.76）% and （8.49 ± 2.47）%, respectively, with statistically significant differences. The ra- tio of CD19＋T cell in PITP-ANA group （25.75± 9.98） % was significantly higher than that in PITP group （ 16.16 ± 8.19） % （P 〈 0.01 ）. The concentration of IgG, IgA, K light chain and k light chain in PITP group, PITP-ANA group and SITP group showed an upward trend and the highest level was in the SITP group, with statistically significant differences among the three groups. A variety of abnormal auto-antibodies could be found in both PITP-ANA group and SITP group. Conclusions We consider that the immune function abnormity of patients in PITP-ANA group were worse than that in PITP group, because the concentration of immunoglobulin, the percentage of B lymphocyte and Treg ratio are higher in than those in PITP group.

关 键 词：免疫性血小板减少性症 自身抗体 巨核细胞 骨髓形态 

分 类 号：R558.2[医药卫生—血液循环系统疾病]