Th17/Treg细胞比例失衡在儿童原发性免疫性血小板减少症中的意义

Significance of Th17/Treg imbalance in children with primary immune thrombocytopenia

摘要:

目的 探讨Th17/Treg 细胞比例失衡在儿童原发性免疫性血小板减少症(ITP)发病及治疗中的意义。方法 选取2015 年5 月至2015 年8 月确诊为ITP 的32 例患儿作为ITP 组,同期选取22 例健康儿童作为健康对照组,采用流式细胞术分别检测初诊ITP 患儿、丙种球蛋白治疗后的ITP 患儿和健康对照组儿童外周血Th17、Treg 细胞的比例。结果 ITP 患儿治疗前外周血Th17 占CD4⁺T 细胞的比例、Th17/Treg 细胞比值均显著高于治疗后及健康对照组儿童(P<0.05),治疗前Treg 细胞占CD4⁺T 细胞的比例显著低于治疗后及健康对照组儿童(P<0.05);32 例ITP 患儿经治疗后,20 例完全反应,4 例有效,8 例无效,完全反应患儿外周血Th17细胞占CD4⁺T 细胞比例、Th17/Treg 细胞比值显著低于无效患儿(P<0.05)。结论 儿童ITP 中存在Th17/Treg细胞比例失衡,丙种球蛋白可通过调节Th17/Treg 细胞比例变化进而改变患儿细胞免疫功能,治疗过程中检测该比值变化可能对疾病的疗效有一定的预测作用。

Abstract:

Objective To investigate the significance of Th17/Treg imbalance in the development and treatment of primary immune thrombocytopenia (ITP) in children. Methods Thirty-two children diagnosed with ITP between May and August, 2015 and 22 healthy children were enrolled. Flow cytometry was used to determine the Th17/Treg ratio in peripheral blood of healthy children and children with ITP before and after treatment with immunoglobulin. Results Compared with the patients with ITP before treatment, the healthy children and the patients treated with immunoglobulin had a significantly lower percentage of Th17 cells in CD4⁺ T cells, a significantly lower Th17/Treg ratio, and a significantly higher percentage of Treg cells in CD4⁺ T cells in peripheral blood (P<0.05). In the 32 ITP children treated with immunoglobulin, 20 had complete response, 4 had response, and 8 had no response. The patients with complete response had a significantly lower percentage of Th17 cells in CD4⁺ T cells and a significantly lower Th17/Treg ratio in peripheral blood than the patients without response (P<0.05). Conclusions The Th17/Treg imbalance can be found in children with ITP. Immunoglobulin can improve the cellular immune function by regulation of the Th17/Treg ratio. The Th17/Treg ratio may serve as an indicator for assessing the therapeutic effects of ITP.