儿童原发性免疫性血小板减少症Th17/Treg平衡及其临床意义  

The Th17/Treg balance in primary immune thrombocytopenia in children and its clinical significance

作　　者：高洁 宋琳琳 李洪娜 谢楠楠 GAO Jie;SONG Linlin;LI Hongna;XIE Nannan(Department of Pediatrics,CANGZHOU People's Hospital,Hebei Cangzhou 061000,China;Department of Pharmacy,CANGZHOU People's Hospital,Hebei Cangzhou 061000,China;Department of Pediatrics,Yihe Maternity and Gynecology Hospital of Cangzhou People's Hospital,Hebei Cangzhou 061000,China)

机构地区：[1]沧州市人民医院儿科,河北沧州061000 [2]沧州市人民医院药学部,河北沧州061000 [3]沧州市人民医院颐和妇产院区家属院儿科,河北沧州061000

出　　处：《中国妇幼健康研究》2025年第1期7-12,共6页Chinese Journal of Woman and Child Health Research

基　　金：河北省医学科学研究项目(20232096)。

摘　　要：目的探讨儿童原发性免疫性血小板减少症(ITP)辅助性T细胞(Th17)/调节性T细胞(Treg)平衡及其临床意义。方法回顾性选取2020年1月至2022年12月本院收治的96例ITP患儿(ITP组)和125例健康儿童(对照组)为研究对象。96例患儿有2例失访,根据预后将剩余94例患儿分为预后良好组(n=74)和预后不良组(n=20)。使用流式细胞仪检测外周血Th17和Treg。收集ITP患儿临床资料,并采用多因素Logistic回归模型分析ITP患儿预后的影响因素;采用受试者工作特征(ROC)曲线分析外周血Th17、Treg和Th17/Treg对ITP患儿预后的预测效能。结果与对照组比较,ITP组Th17、Th17/Treg和白细胞计数(WBC)明显较高(t=8.663、30.730、3.888,P<0.001),而Treg和淋巴细胞计数(ALC)明显较低(t=25.496、16.237,P<0.001)。预后不良组Th17、Th17/Treg明显高于预后良好组(t=5.423、11.174,P<0.001),Treg、血小板计数(PLT)和ALC明显低于预后良好组(t=4.059、7.289、5.347,P<0.001),且两组患者年龄存在显著差异(χ^(2)=8.520,P<0.05)。多因素Logistic回归分析显示,Th17(OR=1.517,95%CI:1.139~2.020)、Th17/Treg(OR=1.765,95%CI:1.285~2.425)均为ITP患儿预后良好的危险因素(P<0.05),Treg(OR=0.932,95%CI:0.877~0.990)、PLT(OR=0.936,95%CI:0.889~0.985)及ALC(OR=0.819,95%CI:0.700~0.958)为其保护因素(P<0.05)。ROC结果显示,Th17、Treg和Th17/Treg单独预测ITP患儿预后的曲线下面积(AUC)分别为0.682(95%CI:0.578~0.775)、0.778(95%CI:0.681~0.857)、0.721(95%CI:0.619~0.809),Th17、Treg和Th17/Treg联合预测ITP患儿预后的敏感度为85.00%、特异度为87.84%,AUC为0.913(95%CI:0.837~0.961),优于Th17(Z=2.481,P=0.013)、Treg(Z=2.549,P=0.011)和Th17/Treg(Z=2.042,P=0.041)单独预测的AUC。结论儿童原发性免疫性血小板减少症的患儿Th17/Treg比例失衡,联合检测Th17、Treg及Th17/Treg可以提高对患儿预后的预测效能,为临床提供重要的参考依据。Objective To explore the balance of helper T cells(Th17)/regulatory T cells(Treg)in children with primary immune thrombocytopenia(ITP)and its clinical significance.Methods A retrospective study was conducted on 96 children with ITP(ITP group)and 125 healthy children(control group)admitted to our hospital from January 2020 to December 2022.Of the 96 children,2 cases were lost to follow-up,and the remaining 94 children were divided into good prognosis group(n=74)and poor prognosis group(n=20)according to prognosis.Peripheral blood Th17 and Treg were detected using flow cytometry.Clinical data of ITP patients were collected,and multivariate logistic regression model was applied to analyze the factors affecting the prognosis of ITP patients.The predictive efficacy of peripheral blood Th17,Treg,and Th17/Treg for the prognosis of ITP patients was analyzed using receiver operating characteristic(ROC)curves.Results Compared with the control group,Th17,Th17/Treg and white blood cell count(WBC)in ITP group were significantly higher(t=8.663,30.730,3.888,P<0.001),while Treg and lymphocyte count(ALC)were significantly lower(t=25.496,16.237,P<0.001).Th17 and Th17/Treg in the poor prognosis group were higher than those in the good prognosis group(t=5.423,11.174,P<0.001),and the Treg,platelet count(PLT)and ALC in the poor prognosis group were significantly lower than those in the good prognosis group(t=4.059,7.289,5.347,P<0.001),and there was significant difference in age between the two groups(χ^(2)=8.520,P<0.05).Multivariate Logistic regression analysis showed that Th17(OR=1.517,95%CI:1.139-2.020),Th17/Treg(OR=1.765,95%CI:1.285-2.425)were all risk factors for good prognosis in ITP children(P<0.05),Treg(OR=0.932,95%CI:0.877-0.990),PLT(OR=0.936,95%CI:0.889-0.985)and ALC(OR=0.819,95%CI:0.700-0.958)were protective factors(P<0.05).The results of ROC showed that the area under the curve(AUC)of Th17,Treg,and Th17/Treg in predicting the prognosis of ITP children was 0.682(95%CI:0.578-0.775),0.778(95%CI:0.681-0.857),0.721(95%CI:0.619-

关 键 词：儿童 原发性免疫性血小板减少症 辅助性T细胞 调节性T细胞 预测 

分 类 号：R179[医药卫生—妇幼卫生保健]