The Expression And Correlation Research Of MDSC,T-lymphocyte Subsets And Cytokines In Relapsed And Refractory Immune Thrombocytopenia Treated By High Dose Of Vitamin C,Rituximab And Glucocorticoid

Objective: This study was examined the expression and correlation of myeloid-derived suppressor cells(MDSCs),T-lymphocyte cell subsets and cytokine in peripheral blood of relapsed and refractory thrombocytopenia(ITP)before and after the treatment of high dose of Vitamin C,lower dose rituximab and glucocorticoid,to investigate the clinical value and immune mechanism of high dose vitamin C in the treatment of relapsed and refractory ITP.Methods: A total of 27 patients with relapsed and refractory ITP diagnosed at the Hematology of the Second Hospital of Lanzhou University from January 2016 to January 2018 were collected and divided into two groups.The test group was given a large dose of vitamin C combined with a small dose of rituximab and glucocorticoids,and the control group was given a small dose of rituximab and glucocorticoids.Flow cytometry was used to detect the number of MDSCs,Th1,Th2,Th17 and regulatory T cells(Treg)in peripheral blood of the case group and the control group.The enzyme-linked immunosorbent assay(ELISA)was used to detect the expression level and relevance of interferon-?(IFN-?),interleukin-4(IL-4),interleukin-10(IL-10)and interleukin-17(IL-17).Results: 1.In the experimental and control groups after treatment,the expression levels of MDSCs,Th2 cells,Treg cells,IL-4 and IL-10 were increased and the expression levels of Th1 cells,Th17 cells,IL-17 and IFN-? were decreased.After treatment,the platelet count,MDSCs,Th2 cells,Treg cells,IL-4,and IL-10 expression levels increased,and Th1 cells,Th17 cells,IL-17,and IFN-? expression levels were higher in the experimental group than in the control group.2.In the peripheral blood samples before treatment,the proportion of MDSCs and the ratio of Th17 cells were negatively correlated;the proportion of MDSCs and the ratiol of Treg cells were positively correlated;the proportion of MDSCs and the level of IL-10 were positively correlated;the proportion of MDSCs and the level of IL-17 were negatively correlated.Conclusion: 1.High doses of vitamin C combined with low doses of rituximab and glucocorticoids was more effective than smaller doses of rituximab and glucocorticoids in the treatment of relapsed and refractory ITP.2.Large dose Vitamin C modulates cellular immune mechanisms by modulating MDSCs,Th1,Th17,Treg and other cells.3.MDSCs may play an important role in relapsed and refractory ITP and may become a target for ITP therapy.4.The exact therapeutic mechanism of high-dose vitamin C Still need further study.