Zhang Jiakui, Zhang Qiuye, Li Yingwei, Tao Lili, Wu Fan, Shen Yuanyuan, Tao Qianshan, Xu Xuanxuan, Wu Can, Ruan Yanjie, Wang Jiyu, Wang Jeffrey, Wang Yiping, Zhai Zhimin
a Department of Hematology, Hematological Research Center , The Second Affiliated Hospital of Anhui Medical University , Hefei , Anhui , People's Republic of China.
b Centre for Transplant and Renal Research , Westmead Institute for Medical Research at University of Sydney , Sydney , New South Wales , Australia.
Hematology. 2018 Sep;23(8):510-516. doi: 10.1080/10245332.2018.1435021. Epub 2018 Feb 6.
To explore the immunological abnormalities in patients with primary immune thrombocytopenia (ITP), and analyze its relationship with treatment.
Proportion of different immune cell subsets were detected in the peripheral blood of 124 ITP patients at different time points and 45 normal controls by flow cytometry. The treatments included glucocorticoids, intravenous IgG as first-line treatment and second-line drugs.
Elevated CD4/CD8 ratio and decreased the proportion of NK and CD4 + CD25 + CD127low regulatory T cells (Tregs) were found in pre-treated ITP patients than healthy controls. The newly diagnosed group had a significantly higher CD4/CD8 ratio than the relapsed group, but no differences in the proportion of B cells, NK cells and Tregs. No relationships were found between the curative effect and the pre-treated cell subsets within both the effective and ineffective groups. Furthermore, compared with the ineffective group, the effective group had higher Tregs and lower CD4/CD8 ratio post-treatment, but no significant differences in NK and B cells.
ITP patients presented with a high CD4/CD8 ratio and low levels of Tregs and NK cells, suggesting that immune deregulation was involved in the pathogenesis of ITP. The pre-treated immune status of ITP patients may not be related to the curative effect. Tregs significantly increased in the effective group post-treatment, highlighting that the mechanism of restoring Tregs may be involved in the treatment of ITP. However, whether or not the targeted regulation of Tregs is an effective treatment for ITP still requires further studies.
探讨原发性免疫性血小板减少症（ITP）患者的免疫异常情况，并分析其与治疗的关系。
采用流式细胞术检测124例ITP患者不同时间点外周血及45例正常对照者外周血中不同免疫细胞亚群的比例。治疗方法包括糖皮质激素、静脉注射免疫球蛋白作为一线治疗及二线药物。
与健康对照相比，初治ITP患者CD4/CD8比值升高，自然杀伤细胞（NK）及CD4⁺CD25⁺CD127低调节性T细胞（Tregs）比例降低。初诊组CD4/CD8比值显著高于复发组，但B细胞、NK细胞及Tregs比例无差异。有效组和无效组的疗效与治疗前细胞亚群之间均未发现相关性。此外，与无效组相比，有效组治疗后Tregs较高，CD4/CD8比值较低，但NK细胞和B细胞无显著差异。
ITP患者CD4/CD8比值升高，Tregs及NK细胞水平降低，提示免疫失调参与ITP的发病机制。ITP患者治疗前的免疫状态可能与疗效无关。有效组治疗后Tregs显著增加，突出恢复Tregs的机制可能参与ITP的治疗。然而，Tregs的靶向调节是否为ITP的有效治疗仍需进一步研究。
