外周血Tfh/Tfr、Breg比例在CITP患者中的临床意义  

Clinical significance of peripheral blood Tfh/Tfr and Breg proportions in patients with chronic immune thrombocytopenia

作　　者：陆田田 佘吉佳[1] 周雪敏 黄春秀[1] 雷振兴 王明明 伍昌林[3] LU Tiantian;SHE Jijia;ZHOU Xuemin;HUANG Chunxiu;LEI Zhenxing;WANG Mingming;WU Changlin(Department of Clinical Laboratory,Shenzhen Municipal Second People′s Hospital,Shenzhen,Guangdong 518035,China;Xinhua Community Health Service Center of Shenzhen Futian District Chronic Disease Hospital,Shenzhen,Guangdong 518048,China;Department of Blood Transfusion,Shenzhen Municipal Second People′s Hospital,Shenzhen,Guangdong 518035,China)

机构地区：[1]广东省深圳市第二人民医院检验科,广东深圳518035 [2]广东省深圳市福田区慢病院新华社康中心,广东深圳518048 [3]广东省深圳市第二人民医院输血科,广东深圳518035

出　　处：《检验医学与临床》2019年第22期3248-3250,3255,共4页Laboratory Medicine and Clinic

基　　金：广东省深圳市科技创新基础研究项目（JCYJ20160425103323074,JCYJ20180228162956597）

摘　　要：目的分析慢性免疫性血小板减少症(CITP)患者外周血滤泡辅助性T细胞(Tfh)/滤泡调节性T细胞(Tfr)、负性调节性B细胞(Breg)比例及相关细胞因子白细胞介素(IL)-21、IL-10的变化,探讨Tfh/Tfr、Breg比例在CITP免疫紊乱中的作用及意义。方法选择30例CITP患者和30例健康体检者,淋巴细胞分离液分离外周血单个核细胞(PBMC),采用流式细胞术检测外周血Tfh、Tfr、Breg比例;采用ELISA检测上清液IL-21与IL-10表达水平;采用流式细胞术检测患者血小板相关抗体(PAIgG)阳性率。结果与健康对照者比较,CITP患者外周血Tfh比例升高,差异有统计学意义(P<0.05);Tfr、Breg比例降低,差异有统计学意义(P<0.05);CITP患者外周Tfh/Tfr升高,差异有统计学意义(P<0.05)。Tfh/Tfr与PAIgG阳性率呈正相关(r=0.622,P<0.05),Breg比例与PAIgG阳性率呈负相关(r=-0.535,P<0.05)。CITP患者外周血IL-21/IL-10升高,差异有统计学意义(P<0.05),IL-21/IL-10与血小板计数呈负相关(r=-0.643,P<0.05),与PAIgG阳性率呈正相关(r=0.548,P<0.05)。结论CITP患者外周血Tfh/Tfr、Breg比例及IL-21/IL-10异常,以上指标参与免疫紊乱机制,可为CITP的临床诊断与治疗提供新思路。Objective To study the changes of follicular helper T cells(Tfh)/follicular regulatory T cells(Tfr),Breg cells proportions and related cytokines(IL-21,IL-10)in the peripheral blood of patients with chronic immune thrombocytopenia(CITP),and to explore the role and significance of Tfh/Tfr,Breg proportions in CITP immunologic derangement.Methods Thirty cases of CITP and 30 people undergoing physical examination were selected.Peripheral blood mononuclear cells were isolated from the lymphocytes separation medium.The changes of peripheral blood Tfh,Tfr,Breg proportions were detected by fluid cytometry(FCM)and the expression levels of IL-21 and IL-10 in supernatant were detected by ELISA.The positive rate of platelet related antibody PAIgG was detected by FCM.Results Compared with the healthy controls,the peripheral blood Tfh proportion was increased,and the difference was statistically significant(P<0.05),while the proportions of Tfr and Breg were decreased,and the difference was statistically significant(P<0.05).Tfh/Tfr in the CITP patients was increased with statistical difference(P<0.05).Tfh/Tfr was positively correlated with the PAIgG positive rate(r=0.622,P<0.05),and Breg proportion was negatively correlated with the PAIgG positive rate(r=-0.535,P<0.05);peripheral blood IL-21/IL-10 levels in the CTIP patients were increase,and the difference was statistically significant(P<0.05);IL-21/IL-10 was negatively correlated with platelet(r=-0.643,P<0.05),and positively correlated with the PAIgG positive rate(r=0.548,P<0.05).Conclusion The abnormalities of peripheral blood Tfh/Tfr,Breg proportions and IL-21/IL-10 in the patients with CITP are involved in its immunologic derangement mechanism,which provides a new idea for clinical diagnosis and treatment of CITP.

关 键 词：慢性免疫性血小板减少症 滤泡辅助性T细胞 滤泡调节性T细胞 负性调节性B细胞 白细胞介素-21 白细胞介素-10 

分 类 号：R558.2[医药卫生—血液循环系统疾病]