血小板输注效果与血小板抗体和Th17/Treg细胞及相关细胞因子的相关性研究  

Research on the correlation between platelet transfusion effect and platelet antibody,Th17/Treg cells and related cytokines

作　　者：王亮[1] 柳国良[1] 温超 陈丽 乔秋芳 Wang Liang;Liu Guoliang;Wen Chao;Chen Li;Qiao Qiufang(Department of Blood Transfusion,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院输血科,061000 [2]河北省沧州中西医结合医院妇科 [3]河北省沧州中西医结合医院输血科

出　　处：《北京医学》2025年第2期159-163,共5页Beijing Medical Journal

基　　金：2023年度河北省医学科学研究课题(20232118)。

摘　　要：目的探讨血小板输注效果与血小板抗体和辅助性T细胞17(T helper cell 17,Th17)/调节性T细胞(regulatory T cell,Treg)及相关细胞因子的关系。方法选取2021年4月至2023年4月沧州市中心医院输注血小板的住院患者216例,根据血小板输注效果分为有效组(n=147)和无效组(n=69)。无效组患者根据血小板抗体表达情况分为血小板抗体阳性表达组(n=58)与血小板抗体阴性表达组(n=11)。比较患者输注前后Th17、Treg细胞比例、血小板抗体水平及血清中IL-6、IL-17、IL-23、TGF-β水平,采用多因素logistic回归分析血小板输注无效(platelet transfusion refractoriness,PTR)的影响因素。结果216例患者中,男126例,女90例,年龄37~58岁,平均(46.0±6.4)岁。与有效组比较,无效组血小板抗体阳性率、Th17细胞比例、Th17/Treg比值、IL-6、IL-17、IL-23水平升高,Treg细胞比例、TGF-β水平降低;与血小板抗体阴性患者比较,血小板抗体阳性患者Th17细胞比例、Th17/Treg比值、IL-6、IL-17、IL-23水平升高,Treg细胞比例、TGF-β水平降低,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,Th17/Treg越高(OR=1.409,95%CI:1.081~1.836,P=0.011)、IL-6越高(OR=1.624,95%CI:1.045~2.524,P=0.031)、IL-17越高(OR=1.931,95%CI:1.181~3.158,P=0.009)、IL-23越高(OR=1.479,95%CI:1.135~1.927,P=0.004)、TGF-β越低(OR=0.627,95%CI:0.452~0.870,P=0.005)、血小板抗体阳性(OR=1.627,95%CI:1.173~2.257,P=0.004)的输注血小板患者发生PTR的风险越高。结论PTR与血小板抗体水平、Th17/Treg细胞平衡及相关细胞因子IL-6、IL-17、IL-23、TGF-β密切相关。Objective To explore the correlation between platelet transfusion effect and platelet antibodies,T helper cell 17(Th17)/regulatory T cell(Treg)and related cytokines.Methods A total of 216 hospitalized patients infused with platelet who underwent treatment in Cangzhou Central Hospital from April 2021 to April 2023 were selected,and were divided into effective group(n=147)and ineffective group(n=69)according to the effectiveness of platelet infusion.Patients in the ineffective group were divided into platelet antibody positive expression group(n=58)and platelet antibody negative expression group(n=11)based on their platelet antibody expression.The proportion of Th17 and Treg cells,the level of platelet antibody and the levels of IL-6,IL-17,IL-23 and TGF-βin serum were compared before and after infusion.The influencing factors of platelet transfusion refractoriness(PTR)was analyzed by multivariate logistic regression.Results Among the 216 patients,there were 126 males and 90 females,aged from 37 to 58 years,with an average of(46.0±6.4)years.Compared with the effective group,the platelet antibody positive rate,Th17 cell ratio,Th17/Treg ratio,IL-6,IL-17 and IL-23 levels in the ineffective group increased,while the Treg cell ratio and TGF-βlevel decreased.Compared with platelet antibody negative patients,platelet antibody positive patients had higher Th17 cell ratio,Th17/Treg ratio,IL-6,IL-17 and IL-23 levels,while the Treg cell ratio and TGF-βlevel decreased,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the higher Th17/Treg(OR=1.409,95%CI:1.081-1.836,P=0.011),the higher IL-6(OR=1.624,95%CI:1.045-2.524,P=0.031),the higher IL-17(OR=1.931,95%CI:1.181-3.158,P=0.009)、the higher IL-23(OR=1.479,95%CI:1.135-1.927,P=0.004),the lower TGF-β(OR=0.627,95%CI:0.452-0.870,P=0.005),and the platelet antibody positive(OR=1.627,95%CI:1.173-2.257,P=0.004),the higher risk of PTR in platelet patients undergoing infusion.Conclusions Platelet antibody levels,Th17/Treg c

关 键 词：血小板输注无效 血小板抗体 辅助性T细胞17 调节性T细胞 

分 类 号：R457.1[医药卫生—治疗学]