再生障碍性贫血患儿血清IL-27、IFN-γ、IL-17的表达及意义

发布时间：2018-05-25 02:16

  本文选题：再生障碍性贫血 + IL-27　； 参考：《郑州大学》2017年硕士论文

【摘要】：目的再生障碍性贫血(aplastic anemia,AA)是一种免疫介导的疾病。IL-27是参与自身免疫性疾病发病的重要细胞因子,可调控T淋巴细胞分化。目前IL-27在AA发病中的作用尚不清楚。因此,本研究通过检测儿童再障患者血清IL-27、IFN-γ及IL-17的表达,分析其血清IL-27水平与IFN-γ、IL-17水平、病情严重程度及免疫抑制治疗疗效之间的关系,进而初步探讨IL-27在儿童AA发病机制中的作用及临床价值。方法病例组选取2015年12月至2016年12月郑州大学第一附属医院儿科门诊及住院治疗的初诊再障患儿(诊断标准参照中华医学会儿科学分会血液学组2014年制定的《儿童获得性再生障碍性贫血诊疗建议》)。共收集AA患儿60例,其中非重型AA(non-severe aplastic anemia,NSAA)组40例,重型AA(severe aplastic anemia,SAA)组20例。同期于我院体检的正常儿童25例为对照组。50例患儿接受免疫抑制治疗,治疗6个月评价疗效。8例患儿观察时间未到,无法评价疗效,余患儿根据疗效标准进一步分为缓解组24例和未缓解组18例。排除患有先天性AA、肿瘤性疾病、骨髓增生异常综合征、阵发性睡眠性血红蛋白尿症、肝脏疾病、营养性贫血、病毒感染、结缔组织病等及曾接受免疫抑制治疗者。采用ELISA法检测60例AA患儿治疗前和25例健康对照者血清IL-27、IFN-γ、IL-17水平。实验数据采用SPSS21.0软件处理。计量资料用均数±标准差()或中位数(下四分位数,上四分位数)[M(P25,P75)]表示,两组间定量资料比较采用t检验或Wilcoxon秩和检验,多组间定量资料比较采用单因素方差分析(one-way ANOVA)或Kruskal-Wallis秩和检验,组间两两比较采用LSD-t检验。定性资料比较用χ2检验,相关分析用Pearson检验。检验水准α=0.05。结果1.SAA组及NSAA组血清IL-27水平分别为(169.98±34.91)pg/ml、(143.52±37.76)pg/ml,显著高于健康对照组(45.67±24.99)pg/ml(P0.001),SAA组血清IL-27水平较NSAA组显著升高(P0.05)。2.SAA组及NSAA组血清IFN-γ水平分别为(48.40±17.36)pg/ml、(37.87±14.79)pg/ml,较健康对照组显著升高(25.82±12.64)pg/ml(P0.05),SAA组血清IFN-γ水平显著高于NSAA组(P0.05)。AA患者血清IL-27与IFN-γ水平呈正相关(SAA:r=0.658,P=0.002;NSAA:r=0.461,P=0.003)。3.SAA组及NSAA组血清IL-17水平分别为(225.65±31.87)pg/ml、(198.37±42.66)pg/ml,显著高于健康对照组(79.37±51.70)pg/ml(P0.001),SAA组血清IL-17水平较NSAA组显著升高(P0.05)。AA患者血清IL-27与IL-17水平无相关性(SAA:P=0.302;NSAA:P=0.350)。4.免疫抑制治疗缓解组血清IL-27水平低于未缓解组(157.96±28.06 vs171.83±26.84),但差异无统计学意义(P0.05)。结论1.IL-27、IFN-γ和IL-17可能参与儿童AA的发病机制,血清IL-27、IFN-γ、IL-17水平与病情严重程度有关,可能有助于再障的病情判断。2.AA患儿血清IL-27水平与免疫抑制治疗疗效无关。
[Abstract]:Objective Aplastic aplastic anemiaa( AAA) is an immune-mediated disease. IL-27 is an important cytokine involved in the pathogenesis of autoimmune diseases and can regulate the differentiation of T lymphocytes. The role of IL-27 in the pathogenesis of AA is unclear. Therefore, by detecting the expression of serum IL-27, IFN- 纬 and IL-17 in children with aplastic anemia, the relationship between the level of serum IL-27 and the level of IFN- 纬 -IL-17, the severity of illness and the efficacy of immunosuppressive therapy was analyzed. The role and clinical value of IL-27 in the pathogenesis of AA in children were discussed. Methods from December 2015 to December 2016, children with aplastic anemia were selected from paediatrics outpatient and inpatient treatment of the first affiliated Hospital of Zhengzhou University. The diagnostic criteria were compared with those of the hematology group of the Chinese Academy of Pediatrics in 2014. Advice on diagnosis and treatment of childhood acquired aplastic anemia. A total of 60 cases of AA were collected, including 40 cases of non-severe AA(non-severe aplastic anemiahe group and 20 cases of severe AA(severe aplastic anemia group. At the same time, 25 normal children in our hospital were treated with immunosuppressive therapy in the control group of 50 cases. The curative effect of 8 cases was not observed for 6 months, and the curative effect could not be evaluated. According to the criteria of curative effect, Yu children were further divided into remission group (n = 24) and non-remission group (n = 18). Exclusion of congenital AAs, tumor diseases, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria, liver disease, nutritional anemia, viral infection, connective tissue disease, and previous immunosuppressive therapy. Serum IL-27 IFN- 纬 -17 levels were measured by ELISA in 60 patients with AA before treatment and 25 healthy controls. The experimental data are processed by SPSS21.0 software. The measurement data were expressed as mean 卤standard deviation) or median (lower quartile, upper quartile) [MNP25P75]. The quantitative data between the two groups were compared by t test or Wilcoxon rank sum test. Single factor ANOVA (one-way ANOVA) or Kruskal-Wallis rank sum test were used to compare the quantitative data between groups and LSD-t test was used to compare the quantitative data between groups. The qualitative data were compared by 蠂 2 test and correlation analysis by Pearson test. The test level is 伪 0. 05. Results the serum IL-27 levels in 1.SAA group and NSAA group were 143.52 卤37.76 ng / ml, respectively, which were significantly higher than those in NSAA group (45.67 卤24.99pg / ml) and NSAA group (48.40 卤17.36pgml / ml, 37.87 卤79pgr / ml, respectively). The serum IFN- 纬 levels in SAA group were significantly higher than those in NSAA group (25.82 卤12.64pgml / ml) and the serum IFN- 纬 level in NSAA group (P < 0.05) was significantly higher than that in control group (P < 0.05 / ml), respectively. The level of serum IFN- 纬 in SAA group was significantly higher than that in NSAA group (P < 0.05). The level of serum IFN- 纬 in SAA group and NSAA group was 48.40 卤17.36 mg / ml and 25.82 卤12.64pgml / g / ml respectively. 鏄捐憲楂樹簬NSAA缁，

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