| ObjectiveWe performed our experiments on both clinical and basical aspects of immune thrombocytopenia (ITP).On basic research, we investigate the quantity of T cell subsets,helper T cells, activated T cells and regulatory T cells in patients with ITP, then expore the relation between T cells immunization and pathogenesis. On clinic,by summarize the clinical features of patients with ITP, we hope to provide a basis for the future diagnosis and treatment.MethodsOn the research of the quantity of T cell subsets, as CD3+T cells, CD3+CD4+T cells(Th),CD3+CD8+T cells(Tc), CD3+CD4+/CD3+CD8+(Th/Tc),helper T cells included of Th1,Th2 and Thl/Th2 ratio change, regulatory T cells(Treg) CD4+CD25+CD127dim proportion and activated CD8+T cells (taken CD25+ and HLA-DR+ as the distinction between early and late activation markers respectively) of 25 inpatients in the hematology department of General Hospital with ITP(Case group) and 16 healthy individuals(Control group) from June 2010 to December 2010 are analyzed by flow cytometry. On clinic, the clinical data, laboratory results and therapeutic effects of 125 inpatients with ITP in our hospital from January 2005 to May 2010 were retrospectively analyzed.ResultsOn the research of the quantity of T cell subsets,in peripheral blood, there was no change in CD3+T lymphocyte between case group(68.74±13.23)and control group (69.14±11.06) (p>0.05),the proportion of CD3+CD4+T lymphocyte(Th) in case group(36.60±6.18) was reduced compared with control group(43.82±13.49) (P<0.01),the proportion of CD3+CD8+T lymphocyte(Tc) was increased in case group (39.04±15.82) compared with control group(30.30±6.42) (P<0.05), the ratio of T lymphocyte subgroup (CD3+CD4+/CD3+CD8+Th/Tc) was declined in case group(0.70±0.26) compared with control group(1.53±0.63)(P<0.05). Median Th1(IFN-γ) in case group was 1.17,and is 0.30 in control group.While Th2(IL-4) in case group was 0.50,and is 0.22 in control group. The ratio of helper T cell subgroup (Th1/Th2) was increased in case group(3.50±2.72) compared with control group(1.86±1.55) (P<0.05). the percentage of CD8+CD25+, CD8+HLA-DR+T cells in CD3+T lymphocytes, the case group were less than the control group. The expression of CD25+,HLA-DR+in CD8+T lymphocyte, the case group were also lower than the control group.But there was no statistically significant (P>0.05). In case group(6.28±2.02) CD4+CD25+CD127dim/CD4+regulatory T cells (Treg)was reduced compared with control group(9.62±5.78) (P<0.05).On clinic, by retrospectively analyzed of 125 inpatients with ITP:the median age was 41, and sex ratio of male to female is 1:1.78. The average pre-treatment platelet count was (28.59±23.05)×109/L.69.1%(67/97) patients suffered from rheumatoid or immune abnormalities.The carriage rate of Hepatitis B virus and parvovirus B19 is 37.3%(22/59) and 44.8%(26/58) respectively. CD3+T cells in chronic patients is (62.7%±14.11%), while that is (55.44%±14.31%) in acute patients.The rate of CD19+B cells in chronic patients is (12.83%±6.96%),that is (19.47%±6.93%) in acute patients.91 patients were subject to the examination for bone marrow monouclear cells antibody,with 45.1%(41/91) cases positive.63.0%(17/27) acute patients were positive, while that was 37.5%(24/64) with chronic patients. Therapy of glucocorticoids combined with cyclosporine showed an efficiency of 81.7% (49/60),some refractory patients showed an efficiency of 57.14%(4/7),and 40.0% (2/5) to small dose of rituximab or azathioprine cytotoxic drugs therapy, respectively.Conclusion The unbalanced T lymphocyte subgroup of Th,Tc,Th/Tc,the polarization of Th1 subgroup,the reduction of Treg companied with the reduced activated T cells may explain the pathogenesis of ITP on celluar immunity. On clinic,these patients with ITP always were accompanied with virus infection or rheumatism abnormalities. Acute patients were always accompanied with hyperfunctioning of humoral immune, while the chronic ones were with hyperfunctioning of the cellular immune function. Patients with positive bone marrow monouclear cells membrane antibody are more likely to be acute. In order to obtain a better effect, the treatment strategies shoud be based on different pathogenesis to choose different drugs. |
PDF Full Text Request