CD8^+CD28^-调节性T细胞及血小板特异性自身抗体在免疫性血小板减少症中的表达  

Expression of CD8^+CD28^- regulatory T-cells and platelet-specific autoantibody in immune thrombocytopenia

作　　者：张小侠 张美玲 杨明珍 Zhang Xiaoxia;Zhang Meiling;Yang Mingzhen(Dept of Hematology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei 230032)

机构地区：[1]安徽医科大学第四附属医院血液内科

出　　处：《安徽医科大学学报》2019年第9期1405-1410,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省2017年度第一批科技计划项目(编号:1704a0802166);安徽省自然科学基金项目(编号:1808085MH299)

摘　　要：目的检测免疫性血小板减少症(ITP)患者外周血中CD8^+CD28^-调节性T细胞(Treg)、血小板特异性自身抗体、细胞因子的表达水平,分析其在ITP发病机制以及临床治疗中的意义。方法 73例ITP患者分为激素治疗组( n =42)、重组人粒血小板生成素(rhTPO)治疗组( n =31),并根据治疗效果分为有效组和无效组。流式细胞术检测患者治疗前后外周血CD8^+CD28^- Treg的表达,流式微球技术检测患者外周血血小板特异性自身抗体的表达。ELISA法检测患者治疗前后转化生长因子(TGF)-β1、白介素(IL)-10和干扰素(IFN)-γ表达水平。以30例健康体检者作为正常对照组。结果① 73例ITP患者治疗前CD8^+CD28^-Treg及细胞因子IL-10、TGF-β1的表达低于正常对照组,IFN-γ表达高于正常对照组( P <0.05),激素及rhTPO治疗后有效组CD8^+CD28^- Treg、IL-10、TGF-β1的表达均比治疗前显著上升,IFN-γ的表达较治疗前显著降低( P <0.05)。无效组CD8^+CD28^- Treg、IFN-γ、IL-10、TGF-β1的表达和治疗前相比均未有明显变化。②根据受试者工作特征曲线(ROC),激素组治疗前CD8^+CD28^-Treg的临界值为14.35,此时预测激素疗效的敏感性和特异性分别为66.7%和73.3%。27例有效者中小于14.35的有18例(66.7%),15例无效者中大于14.35的有11例(73.3%)。rhTPO组治疗前CD8^+CD28^-Treg的临界值为15.45,此时预测rhTPO疗效的敏感性和特异性分别为63.6%和88.9%。22例有效者中大于15.45的有14例(63.6%),9例无效者中小于15.45的有8例(88.9%)。③激素组抗血小板膜糖蛋白Ib(GPIb)抗体阳性患者18例,治疗后有效率44.4%,抗GPIb抗体阴性24例,有效率79.1%,两者比较差异有统计学意义( P <0.05)。结论 CD8^+CD28^- Treg及相关细胞因子的表达异常参与了ITP的发病,激素和rhTPO可能通过改变这种异常发挥作用。治疗前检测CD8^+CD28^-Treg有助于预测激素及rhTPO的疗效。抗GPIb抗体阳性可能是激素治疗不敏感的影响因素之�Objective To detect the expression levels of CD8^+CD28^- regulatory T cells(Treg), platelet-specific autoantibody and cytokines in the peripheral blood of patients with immune thrombocytopenia(ITP), so as to analyze their significance in the pathogenesis and clinical treatment of ITP. Methods 73 ITP patients were divided into hormone treatment group( n =42) and recombinant human thrombopoietin(rhTPO) treatment group( n =31);moreover, they were further divided into response group and non-response group according to the therapeutic effect. Expression of CD8^+CD28^- Treg in the peripheral blood of patients before and after treatment was detected through flow cytometry, and that of platelet-specific autoantibody in the peripheral blood was detected through cytometric bead array. In addition, the expression levels of transforming growth factor(TGF)-β1, interleukin(IL)-10 and interferon(IFN)-γ were also detected in patients before and after treatment according to the ELISA assay. In addition, 30 subjects receiving physical examination were enrolled as the normal control group. Results ① The expression of CD8^+CD28^- Treg as well as the cytokines IL-10 and TGF-β1 in the 73 ITP patients before treatment was lower than that in the normal control group, while IFN-γ expression was higher than that in the normal control group( P <0.05). After hormone and rhTPO treatment, the expression of CD8^+CD28^- Treg, IL-10 and TGF-β1 in the response group was markedly up-regulated compared with that before treatment, while IFN-γ expression was evidently down-regulated relative to that before treatment( P <0.05). Meanwhile, the expression of CD8^+CD28^- Treg, IFN-γ, IL-10 and TGF-β1 in the non-response group showed no obvious change compared with that before treatment.② According to the receiver operating characteristic(ROC) curve, the threshold of CD8^+CD28^-Treg in hormone group before treatment was 14.35, and the sensitivity and specificity in predicting hormone efficacy were 66.7% and 73.3%, respectively, at this time. A

关 键 词：免疫性血小板减少症 CD8^+CD28^-调节性T细胞 血小板特异性自身抗体 

分 类 号：R558.2[医药卫生—血液循环系统疾病]