探讨成人原发免疫性血小板减少症患者外周血淋巴细胞亚群变化及其临床意义

发布时间：2018-05-02 20:02

本文选题：原发免疫性血小板减少症(ITP) + 淋巴细胞亚群　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]通过对成人原发免疫性血小板减少症(ITP)患者外周血淋巴细胞亚群的分析,了解ITP的发病机制,以期运用外周血淋巴细胞亚群检测对成人原发免疫性血小板减少症患者的临床特征、预后及治疗提供指导意义。[方法]收集昆明医科大学第一附属医院血液内科自2016年01月至2017年02月收治的原发免疫性血小板减少症患者共计54例作为研究组,同时选择49例健康体检者作为对照组。对两组的外周血淋巴细胞亚群绝对值进行检测,应用SPSS21.0统计学软件进行统计学分析两组间淋巴细胞亚群的差异,并且对这54例患者进一步从病情严重程度、疾病状态等方面进行分层分析淋巴细胞亚群的差异,以期运用外周血淋巴细胞亚群检测对成人原发免疫性血小板减少症患者的临床特征、预后及治疗提供指导意义。[结果]1.54例ITP患者与49例健康体检者相比:CD3+总T淋巴细胞、CD3+CD4+T细胞、CD3-CD16+CD56+NK细胞减少、CD4+与CD8+T细胞的比值下降,CD3+CD8+T细胞、CD3-CD19+B淋巴细胞增多,且P0.05,差异均具有统计学意义;2.28例新诊断的患者、19例复发难治患者及健康对照组进行各淋巴细胞亚群之间的两两对比,发现新诊断组较健康对照组同样有CD3+总T淋巴细胞、CD3+CD4+T细胞、CD3-D16+D56+NK细胞减少、CD4+与CD8+T细胞的比值下降,CD3+CD8+T细胞、CD3-CD19+B淋巴细胞增多,且P0.05,差异均具有统计学意义;复发难治组较健康对照组也同样有前各淋巴细胞亚群的变化特点,但除了CD19+的B淋巴细胞具有统计学意义外,其余淋巴细胞亚群差异没有统计学意义;新诊断组与复发难治组各淋巴细胞亚群之间比较,P0.05,各淋巴细胞亚群之间差异没有统计学意义;3.重型ITP组、非重型ITP组及健康对照组之间各淋巴细胞亚群进行两两比较,重型ITP、非重型ITP与健康对照相比都呈现CD3+T细胞、CD3+CD4+T细胞、CD4+与CD8+T细胞的比值、CD16+CD56+NK细胞绝对值下降,CD3+CD8+T细胞、CD19+B细胞绝对值上升,P值均0.05,差异有统计学意义;重型ITP组与非重型ITP组相比除CD19+B淋巴细胞外,其余各细胞亚群没有统计学意义,且重型ITP组CD19+B淋巴细胞较非重型减少更明显,差异具有统计学意义(P0.05);4.54例ITP患者治疗前的血小板计数与对应的CD19+的B淋巴细胞绝对值进行相关性分析,ITP患者外周血CD19+B淋巴细胞绝对值与治疗前血小板计数呈负相关(r=-0.274,P=0.045)。[结论]1.ITP发病涉及复杂的免疫学机制,总体特征表现为:CD3+总T淋巴细胞、CD3+CD4+T细胞、CD3-CD16+CD56+NK细胞减少、CD4+与CD8+T细胞的比值下降,CD3+CD8+T细胞、CD3-CD19+B淋巴细胞增多;2.目前国内对于复发难治ITP及重症ITP在免疫学的病因尚未阐明,我中心通过对复发难治ITP及重症ITP患者淋巴细胞亚群的分析发现,CD3-CD19+B淋巴细胞介导的体液免疫可能在其中发挥了重要的作用,这可能为临床上复发难治及重症ITP患者在治疗选择上提供思路。
[Abstract]:[objective] to understand the pathogenesis of ITP by analyzing the lymphocyte subsets in peripheral blood of adult patients with primary immune thrombocytopenia. The purpose of this study was to provide guidance for clinical features, prognosis and treatment of adult primary immune thrombocytopenia by using peripheral blood lymphocyte subsets. [methods] A total of 54 patients with primary immune thrombocytopenia from January 2016 to February 2017 in Department of Hematology, first affiliated Hospital of Kunming Medical University were collected as study group and 49 healthy persons as control group. The absolute value of lymphocyte subsets in peripheral blood of the two groups was detected, and the difference of lymphocyte subsets between the two groups was statistically analyzed by SPSS21.0 software, and the severity of the disease was further analyzed in 54 patients. In order to provide guidance for clinical features, prognosis and treatment of adult patients with primary immune thrombocytopenia, the difference of lymphocyte subsets in peripheral blood was analyzed in this paper. [results] 1.Compared with 49 healthy controls, 54 patients with ITP had increased CD3-CD19 B lymphocytes, CD3-CD16 CD56 NK cells and CD3-CD16 CD56 NK cells decreased the ratio of CD 4 to CD8 T cells. The difference of P0.05 was statistically significant in 2.28 newly diagnosed patients, 19 relapsed and refractory patients and healthy control group were compared with each other among lymphocyte subsets. It was found that in the newly diagnosed group, CD3 total T lymphocytes, CD3 CD4 T cells and CD3-D16D56 NK cells decreased the ratio of CD 4 to CD8 T cells, and CD3 CD8 T cells CD3-CD19 B lymphocytes increased, and the difference was statistically significant (P 0.05). The former lymphocyte subsets in the relapsing refractory group were similar to those in the healthy control group, but there was no significant difference in the other lymphocyte subsets except the B lymphocyte of CD19. There was no significant difference in lymphocyte subsets between the newly diagnosed group and the relapsed refractory group (P 0.05). The lymphocyte subsets of severe ITP group, non-severe ITP group and healthy control group were compared in pairs. The ratio of CD3 T cells to CD3 CD4 T cells CD4 / CD8 T cells decreased the absolute value of CD16 CD56 NK cells increased significantly (P < 0.05). There was no significant difference in the subsets of all the cell subsets except CD19 B lymphocytes between the severe ITP group and the non-severe ITP group, and the decrease of CD19 B lymphocytes in the severe ITP group was more significant than that in the non-severe ITP group. There was a significant difference between the platelet count before treatment and the absolute value of B lymphocytes in the corresponding CD19 in 54 patients with ITP. There was a negative correlation between the absolute value of CD19 B lymphocytes in peripheral blood and the platelet count before treatment in patients with ITP, and there was a negative correlation between the absolute value of CD19 B lymphocytes in peripheral blood and the platelet count before treatment. [conclusion] the pathogenesis of 1.ITP is involved in complicated immunological mechanism, and the overall characteristic is that CD3 CD4 T cells, CD3-CD16 CD56 NK cells decrease the ratio of CD 4 to CD8 T cells, and CD3 CD8 T cells increase CD3-CD19 B lymphocytes. At present, the etiology of relapsing refractory ITP and severe ITP in immunology has not been clarified. Through the analysis of lymphocyte subsets in patients with relapsing and refractory ITP and severe ITP patients, we found that the humoral immunity mediated by CD3-CD19B lymphocytes may play an important role in it. This may provide ideas for the treatment choice of patients with relapsing and refractory and severe ITP.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R558.2

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