调节性T细胞和淋巴细胞亚群在儿童免疫性血小板减少症发病中的意义  

Significance of regulatory T cell and lymphocyte subsets in the pathogenesis of immune thrombocytopenia in children

作　　者：闫彦睿 王志银[2] 李培岭[1] 赵东菊[1] 范蕊[1] 刘豹 石太新[1] YAN Yanrui;WANG Zhiyin;Li Peiling;ZHAO Dongju;FAN Rui;LIU Bao;SHI Taixin(Department of Pediatrics,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Laboratory Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院儿科,河南卫辉453100 [2]新乡医学院第一附属医院检验科,河南卫辉453100

出　　处：《新乡医学院学报》2021年第2期129-132,136,共5页Journal of Xinxiang Medical University

基　　金：河南省医学科技攻关计划项目(编号:201702122)。

摘　　要：目的探讨调节性T细胞(Treg)和淋巴细胞亚群在儿童免疫性血小板减少症(ITP)发病中的意义。方法选择2019年4月至2020年8月新乡医学院第一附属医院收治的33例初诊ITP患儿为观察对象(ITP组),另选择同期门诊体检健康的年龄和性别匹配的20例儿童为对照组。ITP组受试者于入院当日、对照组受试者于体检当日采集外周静脉血2 mL,置于乙二胺四乙酸抗凝管内,轻轻混匀,使用DxFLEX流式细胞仪检测Treg水平和淋巴细胞亚群CD4^(+)细胞、CD8^(+)细胞、CD19+B细胞水平,使用XN-2000型全自动血细胞分析仪检测血小板计数,采用固相凝集法检测血小板抗体。结果ITP组与对照组受试者外周血Treg水平分别为(6.78±1.57)%、(8.36±1.20)%,血小板计数分别为(16.45±15.49)×10^(9)L^(-1)、(239.30±56.74)×10^(9)L^(-1);ITP组受试者外周血Treg水平及血小板计数均显著低于对照组(t=-3.848、-17.182,P<0.05)。ITP组受试者CD4^(+)细胞百分比、CD4^(+)/CD8^(+)显著低于对照组(P<0.05);ITP组受试者CD8^(+)细胞百分比显著高于对照组(P<0.05);ITP组受试者CD19+B细胞百分比与对照组比较差异无统计学意义(P>0.05)。Pearson相关分析显示,ITP组受试者外周血Treg水平与血小板计数无相关性(r=-0.152,P>0.05)。ITP组33例患儿中,血小板抗体阳性14例,血小板抗体阴性19例,血小板抗体阳性率为42.4%(14/33);血小板抗体阳性和血小板抗体阴性ITP患儿的外周血Treg水平分别为(7.14±1.95)%、(6.52±1.21)%,外周血CD4^(+)细胞水平分别为(31.82±8.35)%、(34.98±7.11)%;血小板抗体阳性与血小板抗体阴性ITP患儿外周血Treg水平、CD4^(+)细胞水平比较差异无统计学意义(t=1.050、-1.173,P>0.05)。结论ITP患者外周血Treg水平、CD4^(+)细胞百分比和CD4^(+)/CD8^(+)比值降低,CD8^(+)细胞百分比升高,提示ITP的发病机制与细胞免疫失衡有关。Objective To explore the significance of regulatory T cells(Treg)and lymphocyte subsets in the pathoge-nesis of childhood immune thrombocytopenia(ITP).Methods A total of 33 children with newly diagnosed ITP admitted to the First Affiliated Hospital of Xinxiang Medical University from April 2019 to August 2020 were selected as observation objects(ITP group),and 20 children with the matching age and gender who were healthy during the outpatient physical examination in the same period were selected as the control group.Two milliliters of peripheral venous blood of the subjects in the ITP group on the day of admission and subjects in the control group on the day of physical examination were collected.The peripheral venous blood was placed in an ethylenediaminetetraacetic acid anticoagulation tube and mixed gently.The Treg level and the cell levels of lymphocyte subsets CD4^(+)cells,CD8^(+)cells,CD19+B cells in anticoagulant blood were detected by DxFLEX flow cytometer;the platelet count in anticoagulant blood was detected by XN-2000 automatic blood cell analyzer;the platelet antibodies in anticoagulant blood was detected by solid phase agglutination method.Results The Treg levels in peripheral blood of subjects in the ITP group and the control group were(6.78±1.57)%and(8.36±1.20)%,and the platelet counts were(16.45±15.49)×10^(9)L^(-1)and(239.30±56.74)×10^(9)L^(-1),respectively.The Treg levels and platelet counts in peripheral blood of subjects in the ITP group were significantly lower than those in the control group(t=-3.848,-17.182;P<0.05).The percentage of CD4^(+)cells and CD4^(+)/CD8^(+)ratio of subjects in the ITP group were significantly lower than those in the control group(P<0.05);the percentage of CD8^(+)cells of subjects in the ITP group was significantly higher than that in the control group(P<0.05);there was no significant difference in the percentage of CD19+B cells of subjects between the ITP group and control group(P>0.05).Pearson correlation analysis showed that there was no significant correlati

关 键 词：免疫性血小板减少症 调节性T细胞 淋巴细胞亚群 

分 类 号：R725.5[医药卫生—儿科]