Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden.
Ann Hematol. 2012 Feb;91(2):271-7. doi: 10.1007/s00277-011-1292-2. Epub 2011 Jul 23.
Platelets are targeted by autoantibodies and destroyed in the reticuloendothelial system in the spleen, liver and bone marrow in patients with immune thrombocytopenia (ITP). Other mechanisms such as destruction by cytotoxic T-cells and defective production of platelets in the bone marrow also exist. Splenectomy normalizes the platelet count in 70% of ITP patients, however, precious little is known about the spleen in this disease. Our aim was therefore to investigate the splenic morphology and especially the number and localization of splenic leukocytes in patients with ITP and controls and to evaluate factors predicting outcome of splenectomy. Spleen sections from 29 ITP patients and 11 individuals splenectomized due to trauma were analyzed by immunohistochemistry. All except one of the ITP patients had a normalized platelet count 12 months after splenectomy and the platelet count was inversely correlated with age. ITP patients had an increased number of B-cells in the red pulp. The number of white pulp B-cells and number of T-cells in both compartments was unchanged. In conclusion, B-cells are increased in the red pulp of the spleen and together with cytotoxic T-cells, helper T-cells and macrophages line the sinusoids enabling the immunological attack on platelets in ITP.
血小板在免疫性血小板减少症 (ITP) 患者中会被自身抗体靶向，并在脾脏、肝脏和骨髓的网状内皮系统中被破坏。此外，还存在其他机制，如细胞毒性 T 细胞破坏和骨髓中血小板生成缺陷。脾切除术可使 70%的 ITP 患者血小板计数正常化，但对于这种疾病中的脾脏，人们知之甚少。因此，我们的目的是研究 ITP 患者和对照者的脾脏形态学，特别是脾脏白细胞的数量和定位，并评估预测脾切除术结果的因素。通过免疫组织化学分析了 29 名 ITP 患者和 11 名因外伤而脾切除术的个体的脾组织切片。除一名患者外，所有 ITP 患者在脾切除后 12 个月血小板计数均正常化，血小板计数与年龄呈负相关。ITP 患者的红髓中 B 细胞数量增加。白髓中 B 细胞和 T 细胞的数量不变。总之，B 细胞在脾脏的红髓中增加，与细胞毒性 T 细胞、辅助 T 细胞和巨噬细胞一起排列在窦状隙中，使 ITP 中对血小板的免疫攻击成为可能。
