原发性免疫性血小板减少症患者脾切除术前T淋巴细胞亚群检测的临床意义

黎建云; 涂传清; 贺德; 王典文; 黄灿; 张旭艳; 冯春

doi:10.3969/j.issn.1001-5256.2017.01.033

原发性免疫性血小板减少症患者脾切除术前T淋巴细胞亚群检测的临床意义

DOI: 10.3969/j.issn.1001-5256.2017.01.033

1. 深圳市宝安区人民医院血液内科
2. 深圳市宝安区人民医院普通外科一区

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中图分类号: R558.2;R657.6
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出版历程
- 出版日期: 2017-01-20

Clinical significance of measurement of T lymphocyte subsets before splenectomy in patients with primary immune thrombocytopenia

Department of Hematology, The People′s Hospital of Bao′an District, Shenzhen, Guangdong 518101, China

摘要

摘要:
目的分析激素治疗无效或停药后复发的原发性免疫性血小板减少症（ITP）患者脾切除术前T淋巴细胞亚群、自然杀伤细胞的变化,探讨其与脾切除后ITP早期复发的关系。方法收集2009年1月-2015年12月于深圳市宝安区人民医院治疗的ITP脾切除患者32例,随访时间360个月,按脾切除疗效分为早期复发组（脾切除后6个月内复发,PLT<30×109 plt="">30×109/L且较切除前PLT增加2倍以上）。应用流式细胞技术检测患者脾切除术前外周血T淋巴细胞亚群（CD3+CD4+、CD3+CD8+、CD3+CD4+/CD3+CD8+、CD3-CD19+）及CD56+CD16+自然杀伤细胞的百分比（CD3-/CD16+CD56+）。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验或Fisher检验。结果早期复发组患者11例（占34.4%）,有效组21例（占65.6%）。早期复发组脾切除术前CD3+CD4+、CD3+CD4+/CD3+CD8+明显低于有效组[（21.7±5.4）%vs（32.6±4.1）%,t=6.39,P=0.015;0.6...
- 血小板减少 /
- 脾切除术 /
- T淋巴细胞亚群 /
- 杀伤细胞,天然
Abstract:
Objective To investigate the changes in lymphocyte subsets and natural killer( NK) cells before splenectomy in patients with primary immune thrombocytopenia( ITP) who have no response to corticosteroid therapy or experience recurrence after drug withdrawal,as well as their association with early ITP recurrence after splenectomy. Methods A total of 32 patients with ITP who were treated with splenectomy in The People's Hospital of Bao'an District from January 2009 to December 2015 and followed up for 3- 60 months were enrolled and divided into early recurrence group( with recurrence within 6 months after splenectomy and platelet count < 30 × 109/ L) and response group( platelet count > 30 × 109/ L after splenectomy,two- fold increase compared with before splenectomy) according to the outcome of splenectomy. Flow cytometry was used to measure the percentages of peripheral blood lymphocyte subsets( CD3+CD4+,CD3+CD8+,CD3+CD4+/ CD3+CD8+,and CD3-CD19+) and CD56+CD16+NK cells before splenectomy. The t- test was used for comparison of continuous data between groups and the chi- square test or Fisher's exact test was used for comparison of categorical data between groups. Results There were 11 patients( 11 /32,34. 4%) in the early recurrence group and 21( 21 /32,65. 6%) in the response group. Compared with the response group,the early recurrence group had a significantly lower percentage of CD3+CD4+( 21. 7% ± 5. 4% vs 32. 6% ± 4.1%,t = 6. 39,P = 0. 015) and a significantly lower CD3+CD4+/ CD3+CD8+ratio( 0. 65 ± 0. 21 vs 1. 29 ± 0. 36,t = 3. 92,P = 0. 003),as well as a significantly higher percentage of 〗CD3+CD8+T cells( 34. 5% ± 5. 9% vs 26. 8% ± 6. 6%,t =- 3. 20,P = 0. 030) before splenectomy. There were no significant differences in CD3-/ CD16+CD56+ratio and the percentage of CD3-CD19+T cells between the two groups( both P > 0. 05). Conclusion ITP patients with a low percentage of CD3+CD4+T cells and a low CD3+CD4+/ CD3+CD8+ratio before splenectomy tend to experience recurrence after surgery,which suggests that abnormal T lymphocyte subsets can be used as one of the reference indices for predicting the clinical outcome of splenectomy in ITP patients.
- thrombocytopenia /
- splenectomy /
- T-lymphocyte subsets /
- killer cells

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参考文献(17)

[1]ZHOU X,YAN X.Clinical efficacy of laparoscopic splenectomy for immune thrombocytopenic purpura[J].Chin J Dig Surg,2015,14(9):746-749.(in Chinese)周雄,阎雄.腹腔镜脾切除术治疗免疫性血小板减少性紫癜的临床疗效[J].中华消化外科杂志,2015,14(9):746-749.

[2] Thrombosis and Hemostasis Group,Hematology Society.Consensus of Chinese experts on diagnosis and treatment of adult primary immune thrombocytopenia(version 2016)[J].Chin J Hematol,2016,37(2):89-93.(in Chinese)中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89-93.

[3] LI Y,LI H,WANG L,et al.Efficacy and feasibility of laparoscopic splenectomy in patients with a low platelet count[J].Chin J Hepatobiliary Surg,2016,22(2):107-110.(in Chinese)李扬,李灏,王磊,等.血小板减少患者行腹腔镜脾切除的可行性及疗效[J].中华肝胆外科杂志,2016,22(2):107-110.

[4]ZHANG H,WU ZJ,YAN X,et al.Laparoscopic splenectomy for idiopathic thrombocytopenic purpura:a clinical analysis of 62 cases[J].J Clin Surg,2016,24(8):602-604.(in Chinese)张华,吴忠均,阎雄,等.腹腔镜脾切除术治疗特发性血小板减少性紫癜62例临床分析[J].临床外科杂志,2016,24(8):602-604.

[5]MIKHAEL J,NORTHRIDGE K,LINDQUIST K,et al.Shortterm and long-term failure of laparoscopic splenectomy in adult immune thrombocytopenic purpura patients:a systematic review[J].Am J Hematol,2009,84(11):743-748.

[6]TOMIYAMA Y,KOSUGI S.Autoantigenic epitopes on platelet glycoproteins[J].Int J Hematol,2005,81(2):100-105.

[7]Mc MILLAN R,WANG L,TANI P.Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura(ITP)[J].J Thromb Haemost,2003,1(3):485-491.

[8]KASHIWAGI H,TOMIYAMA Y.Pathophysiology and management of primary immune thrombocytopenia[J].Int J Hematol,2013,98(1):24-33.

[9]SAKAGUCHI S.Naturally arising Foxp3-expressing CD25+CD4+regulatory T cells in immunological tolerance to self and non-self[J].Nat Immunol,2005,6(4):345-352.

[10]NISHIMOTO T,KUWANA M.CD4+CD25+Foxp3+regulatory T cells in the pathophysiology of immune thrombocytopenia[J].Semin Hematol,2013,50(Suppl 1):s43-s49.

[11]CHOW L,ASLAM R,SPECK ER,et al.A murine model of severe immune thrombocytopenia is induced by antibody-and CD8+T cell-mediated responses that are differentially sensitive to therapy[J].Blood,2010,115(6):1247-1253.

[12]PARK YH,YI HG,KIM CS,et al.Clinical outcome and predictive factors in the response to splenectomy in elderly patients with primary immune thrombocytopenia:a multicenter retrospective study[J].Acta Haematol,2016,135(3):162-171.

[13]ZHENG CX,JI ZQ,ZHENG D,et al.Value for detection of peripheral blood T-lymphocyte subsets before and after splenectomy in patients with immune thrombocytopenic purpura[J/CD].Chin J Clinicians:Electronic Edition,2010,4(10):1808-1812.(in Chinese)郑朝旭,纪壮奇,郑冬,等.免疫性血小板减少性紫癜患者脾切除术前后外周血T细胞亚群的检测意义[J/CD].中华临床医师杂志:电子版,2010,4(10):1808-1812.

[14]MA LF,WANG CY,WANG R,et al.Changes of T lymphocyte subsets in patients with idiopathic thrombocytopenic purpura after laparoscopic splenectomy[J].Clin Med China,2015,31(4):340-342.(in Chinese)马利锋,王晨宇,王若,等.特发性血小板减少性紫癜患者腹腔镜脾切除术后T淋巴细胞亚群的变化[J].中国综合临床,2015,31(4):340-342.

[15]CURRAO M,BALDUINI CL,BALDUINI A.High doses of romiplostim induce proliferation and reduce proplatelet formation by human megakaryocytes[J].PLo S One,2013,8(1):e54723.

[16]LIU XG,LIU S,FENG Q,et al.Thrombopoietin receptor agonists shift the balance of Fcγreceptors toward inhibitory receptorⅡb on monocytes in ITP[J].Blood,2016,128(6):852-861.

[17]KUTER DJ,BUSSEL JB,NEWLAND A,et al.Long-term treatment with romiplostim in patients with chronic immune thrombocytopenia:safety and efficacy[J].Br J Haematol,2013,161(3):411-423.

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