Significance Of T Lymphocyte-related Cytokines In The Prognosis Of Immune Thrombocytopenia In Children

BackgroundImmune thrombocytopenic(ITP)is one of the most common immune and hemorrhagic diseases in children,most of them have a good prognosis,10%to 20%are converted to chronic ITP or refractory ITP,may be related to persistent immune function disorders.Chronic ITP or refractory ITP has a long treatment time,poor treatment response,easy to repeat disease,high risk of bleeding,and severely degraded quality of life.It is not yet possible to predict the outcome of ITP.A number of studies at home and abroad based on the clinical and laboratory characteristics of children with ITP to predict their disease duration,analysis of prognostic factors affecting children's ITP.However,there are few studies on the influence of T lymphocyte-related cytokines on the course and prognosis of children with ITP,and its role and significance in its prognosis are still unclear.Objective1.Cytometric bead array(CBA)technique was used to detect the cytokines IL-2,IFN-?,TNF,IL-4,IL-6,IL-10,IL-17A in peripheral blood of children with ITP,and the significance of their level changes in the clinical outcome of children with ITP was analyzed.2.To analyze the clinical characteristics of ITP in children and explore the related factors affecting prognosis.Methods1.108 patients with complete ITP and follow-up records were enrolled in the Department of Pediatrics,First Affiliated Hospital of Xinxiang Medical College from July2016 to December 2017.The patients were assessed for disease outcome according to the follow-up results.The situation was divided into three groups,namely,the newly diagnosed ITP group,the persistent ITP group,and the chronic ITP group.Forty patients with healthy physical examination in our outpatient clinic served as a control group.2.The CBA technique was used to detect the levels of cytokines IL-2,IFN-?,TNF,IL-4,IL-6,IL-10 and IL-17A in the experimental group before treatment,in the chronic ITP patients 12 months after treatment and in the control group.Analysis of the relationship between cytokines and prognosis of children with ITP.3.Statistical analysis of clinical characteristics of each group of ITP patients and other relevant data.4.The data were analyzed by SPSS22.0 statistical software.Results1.Analysis of clinical characteristics of ITP patientsAmong 108 ITP patients,the newly diagnosed,persistent,and chronic ITP accounted for 62.0%,23.2%,and 14.8%,respectively.The male to female ratio was 1.3:1,the age ranged from 1 to 156 months,and the average age was(40.80±37.40)months.The onset season was mostly in spring and summer,accounting for 67.6%;52.8%had a history of prodromal disease 4 to 6 weeks before onset;76.9%acute onset,23.1%chronic onset;90.7%with bleeding,no bleeding 9.3%,of which 66.3%of patients with dry bleeding,33.7%of patients with wet bleeding;the number of platelets(PLT)in the initial diagnosis(1-85)×10~9/L,the average was(22.75±21.24)×10~9/L,33.3%of the patients were less than20×10~9/L and 66.7%of the patients were newly diagnosed with PLT greater than 20×10~9/L.There were significant differences in age,onset pattern,PLT at diagnose(P<0.05),but there were no significant differences in gender,onset season,history of precursor diseases and bleeding type(P>0.05).2.Cytokine levels in each groupTh1 type cytokines:The IL-2 levels in the newly diagnosed,persistent,and chronic ITP group were significantly higher than those in the control group,the chronic ITP group was significantly higher than the newly diagnosed,persistent ITP group,there were significant differences(P<0.05).and the persistent ITP group was higher than the newly diagnosed ITP group,but there was no significant difference(P>0.05).There were no significant differences in the levels of IFN-?and TNF between the four groups(P>0.05).Th2 type cytokines:The levels of IL-4 and IL-10 in the newly diagnosed,persistent,and chronic ITP group were lower than those in the control group,and the chronic ITP group was significantly lower than the newly diagnosed ITP group,there were significant differences(P<0.05).The chronic ITP group was lower than the persistent ITP group,and the persistent ITP group was lower than the newly diagnosed ITP group,but there was no significant difference(P>0.05).There was no significant difference in IL-6 levels between the four groups(P>0.05).Th17 type cytokines:IL-17A levels in newly diagnosed,persistent,and chronic ITP groups were significantly higher than those in the control group,and the chronic ITP group was significantly higher than the new diagnosis group,there were significant differences(P<0.05).The persistent group was higher than the new diagnosis group,and the chronic ITP group was higher than continuous,but there was no significant difference(P>0.05).3.Cytokine levels in patients with chronic ITP before and 12 months after treatmentThe levels of IL-2,IL-6,and INF-?in patients with chronic ITP decreased 12 months after treatment,but there was no significant difference before treatment(P>0.05).IL-4,IL-10,TNF,IL-17A levels were higher than before treatment,and no Significant difference(P>0.05).Conclusions1.The levels of IL-2 and IL-17A are increased,and the levels of IL-4 and IL-10 are decreased in serum of patients with ITP,this is significant in chronic patients,which may be related to the chronic development of the disease,which helps to judge the outcome of ITP patients.2.older age,chronic onset and newly diagnosed PLT?20×10~9/L are may risk factors for patients with ITP to become chronic.