调节性B细胞在免疫性血小板减少症中水平及临床意义的初步探究

发布时间：2018-05-18 01:39

本文选题：调节性B细胞 + 免疫性血小板减少症　；参考：《济宁医学院》2017年硕士论文

【摘要】：目的:通过检测免疫性血小板减少症疾病患者及健康者外周血中CD19+CD24hiCD38hi调节性B细胞的水平及其功能的变化,探讨调节性B细胞在ITP疾病的发生、出血风险、发展、转归及预后中所起的作用,深入研究调节性B细胞与ITP发病机理的关系。方法:选取2015年01月01日至2016年12月31日于济宁医学院附属医院血液科门诊就诊或住院的免疫性血小板减少症(Immune thrombocytopenia,ITP)患者124例作为实验组;选取同期年龄、性别匹配的37例健康人群作为对照组。并根据ITP的分型及分期标准,将ITP患者分为四个不同的组别:新诊断的ITP组、持续性ITP组、慢性ITP组和重症ITP组。根据疗效标准将完全缓解组,分别比较激素治疗前后,及其与持续性ITP组、慢性ITP组及重症ITP组进行比较。采用流式细胞学检测研究对象外周血中的CD19+CD24hiCD38hi调节性B细胞(Regulatory B cells,Bregs)及其功能分子白介素-10(interleukin-10,IL-10)的水平,比较它们在ITP组和健康对照组的水平差异,以及在ITP各亚组之间的水平差异;采用原发免疫性血小板减少症出血评分系统对ITP组进行评分;所有受试对象进行血常规、骨髓穿刺等指标的检测。选取一般人口学资料、血小板计数、出血评分作为参数,通过相关分析,初步探讨影响Bregs功数量和功能的可能影响因素及其意义。结果:免疫性血小板减少症患者外周血中的Bregs的水平(2.7519%±1.71625%)显著低于对照组(8.3195%±0.98072%)(P0.05),且IL-10的水平(2.5059%±1.55297%)亦均低于健康组(7.0257%±0.78238%)(P0.05)。且在研究的ITP各亚组中,Bregs及其功能分子IL-10在持续性、慢性、重症ITP组的人群中水平表达更低。但是,在完全缓解组中,Bregs的水平较治疗前有明显升高(P0.05),且比ITP其他亚组表达显著增加(P0.05)。另外,通过相关分析发现:Bregs与外周血PLT的水平(r=0.829,p0.05)、与ITP疾病的严重程度(r=0.434,p0.05)呈显著正相关,与ITP出血评分呈负相关(r=-0.771,p0.05);Bregs功能分子IL-10与外周血PLT的水平(r=0.742,p0.05)、与ITP疾病的严重程度(r=0.358,p0.05)呈显著正相关,与ITP出血评分呈负相关(r=-0.668,p0.05)。结论:调节性B细胞可能参与了免疫性血小板减少症的发生以及发展,且与免疫性血小板减少症疾病的严重程度明显相关,其可作为评估ITP的严重程度、疾病分型、出血风险的一个参考指标,也可作为评估诊断疗效、疾病转归及预后的十分有效的一个指标。调节性B细胞可作为难治性ITP患者免疫治疗的新靶点。
[Abstract]:Objective: to detect the level and function of CD19 CD24hiCD38hi regulatory B cells in peripheral blood of patients with immune thrombocytopenia and healthy subjects, and to explore the occurrence, bleeding risk and development of regulatory B cells in ITP disease. To study the relationship between regulatory B cells and the pathogenesis of ITP. Methods: 124 patients with immune thrombocytopenia were selected as experimental group from January 01, 2015 to December 31, 2016 in the Department of Hematology, affiliated Hospital of Jining Medical College. Sex matched 37 healthy people as control group. According to the classification and staging of ITP, the patients with ITP were divided into four groups: newly diagnosed ITP group, persistent ITP group, chronic ITP group and severe ITP group. According to the therapeutic criteria, complete remission group was compared with persistent ITP group, chronic ITP group and severe ITP group before and after hormone therapy. Flow cytometry was used to detect the levels of CD19 CD24hiCD38hi regulatory B cells in peripheral blood and its functional molecule interleukin-10 (IL-10) in peripheral blood, and to compare their levels in ITP group and healthy control group, as well as among ITP subgroups. The primary immune thrombocytopenia haemorrhage scoring system was used to evaluate the ITP group, and all subjects were tested for blood routine examination and bone marrow puncture. The general demographic data, platelet count and bleeding score were selected as parameters. By correlation analysis, the possible influencing factors and their significance of Bregs work quantity and function were preliminarily discussed. Results: the level of Bregs in peripheral blood of the patients with immunological thrombocytopenia was 2.7519% 卤1.71625), which was significantly lower than that of the control group (8.3195% 卤0.98072), and the level of IL-10 was 2.50% 卤1.552977%, which was also lower than that of the healthy group (7.02577% 卤0.78238P 0.05). The expression of Bregs and its functional molecule IL-10 in the subgroups of ITP was lower in the persistent chronic and severe ITP groups. However, the level of Bregs in complete remission group was significantly higher than that before treatment, and the expression of Bregs was significantly higher than that of other subgroups of ITP. In addition, by correlation analysis, it was found that there was a significant positive correlation between the level of PLT in peripheral blood and the level of Bregs in peripheral blood, 0.829, p0.05a, and the severity of ITP disease, 0.434 (p0.05). There was a negative correlation between IL-10 and the level of PLT in peripheral blood, and a significant positive correlation with the severity of ITP disease, and a negative correlation with the score of ITP hemorrhage. Conclusion: regulatory B cells may be involved in the occurrence and development of immune thrombocytopenia, and may be associated with the severity of immune thrombocytopenia. It can be used to evaluate the severity and classification of ITP. A reference indicator for the risk of bleeding can also be used as a very effective indicator for evaluating the efficacy, outcome and prognosis of the disease. Regulatory B cells may be a new target for immunotherapy in patients with refractory ITP.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R558.2

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