中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2013年
6期
478-481
,共4页
李振宇%李德鹏%闫志凌%邢伟伟%刘凯歌%曹江%何徐彭%潘秀英%徐开林
李振宇%李德鵬%閆誌凌%邢偉偉%劉凱歌%曹江%何徐彭%潘秀英%徐開林
리진우%리덕붕%염지릉%형위위%류개가%조강%하서팽%반수영%서개림
血小板减少症,免疫性%单克隆抗体,CD20%糖皮质激素%调节性T细胞
血小闆減少癥,免疫性%單剋隆抗體,CD20%糖皮質激素%調節性T細胞
혈소판감소증,면역성%단극륭항체,CD20%당피질격소%조절성T세포
Thrombocytopenia,immune%Rituximab%Glucocorticoids%Regulatory T cell
目的 观察原发免疫性血小板减少症(ITP)患者治疗前后外周血调节性T细胞(Treg)水平变化,初步探讨Treg细胞在ITP发病中的作用.方法 选取138例新诊断ITP患者,男57例、女81例,中位年龄40(18 ～70)岁.按治疗方案随机分为①泼尼松组(49例):泼尼松1.5 mg·kg-1·d-1口服；②地塞米松组(45例):地塞米松40 mg/d第1～4天口服；③地塞米松+小剂量利妥昔单抗组(44例):地塞米松40 mg/d第1～4天口服,利妥昔单抗100 mg第7、14、21、28天静脉滴注.各组患者于治疗前、治疗后14 d和28 d分别采取外周静脉血,采用流式细胞术检测CD4+ CD25highCD127low细胞(Treg)水平.以30名健康体检者为正常对照组.结果 治疗后第28天,泼尼松组、地塞米松组、地塞米松+小剂量利妥昔单抗组的总有效率分别为69.4％、66.7％、79.5％,差异无统计学意义；随访12个月,地塞米松+小剂量利妥昔单抗组持续有效率(66.7％)高于泼尼松组(37.8％)和地塞米松组(22.7％),差异有统计学意义(P＜0.05),泼尼松与地塞米松组之间差异无统计学意义.138例ITP患者治疗前外周血CD4+ CD25high CD127kw细胞表达水平低于健康对照组[(1.67±0.70)％对(4.02±0.39)％,P＜0.05]；地塞米松+小剂量利妥昔单抗组治疗后14、28 d CD4+ CD25 highCD127low细胞水平[(4.28±1.09)％、(4.44±0.63)％]均高于治疗前[(1.68±0.68)％],差异有统计学意义(P值均＜0.05)；泼尼松组、地塞米松组患者治疗后14 d CD4+ CD25highCD127low细胞水平均高于治疗前[(3.47±0.77)％对(1.69±0.73)％、(3.23±0.78)％对(1.70±0.75)％,P值均＜0.05]；治疗后28 d,泼尼松组、地塞米松组患者CD4+ CD25high CD127low细胞水平[(2.69±0.64)％、(2.59±0.67)％]与治疗前比较差异无统计学意义.结论 新诊断ITP患者外周血Treg细胞水平低于健康对照组；地塞米松联合小剂量利妥昔单抗提升Treg细胞数量及长期疗效方面优于泼尼松和地塞米松单药方案.
目的 觀察原髮免疫性血小闆減少癥(ITP)患者治療前後外週血調節性T細胞(Treg)水平變化,初步探討Treg細胞在ITP髮病中的作用.方法 選取138例新診斷ITP患者,男57例、女81例,中位年齡40(18 ～70)歲.按治療方案隨機分為①潑尼鬆組(49例):潑尼鬆1.5 mg·kg-1·d-1口服；②地塞米鬆組(45例):地塞米鬆40 mg/d第1～4天口服；③地塞米鬆+小劑量利妥昔單抗組(44例):地塞米鬆40 mg/d第1～4天口服,利妥昔單抗100 mg第7、14、21、28天靜脈滴註.各組患者于治療前、治療後14 d和28 d分彆採取外週靜脈血,採用流式細胞術檢測CD4+ CD25highCD127low細胞(Treg)水平.以30名健康體檢者為正常對照組.結果 治療後第28天,潑尼鬆組、地塞米鬆組、地塞米鬆+小劑量利妥昔單抗組的總有效率分彆為69.4％、66.7％、79.5％,差異無統計學意義；隨訪12箇月,地塞米鬆+小劑量利妥昔單抗組持續有效率(66.7％)高于潑尼鬆組(37.8％)和地塞米鬆組(22.7％),差異有統計學意義(P＜0.05),潑尼鬆與地塞米鬆組之間差異無統計學意義.138例ITP患者治療前外週血CD4+ CD25high CD127kw細胞錶達水平低于健康對照組[(1.67±0.70)％對(4.02±0.39)％,P＜0.05]；地塞米鬆+小劑量利妥昔單抗組治療後14、28 d CD4+ CD25 highCD127low細胞水平[(4.28±1.09)％、(4.44±0.63)％]均高于治療前[(1.68±0.68)％],差異有統計學意義(P值均＜0.05)；潑尼鬆組、地塞米鬆組患者治療後14 d CD4+ CD25highCD127low細胞水平均高于治療前[(3.47±0.77)％對(1.69±0.73)％、(3.23±0.78)％對(1.70±0.75)％,P值均＜0.05]；治療後28 d,潑尼鬆組、地塞米鬆組患者CD4+ CD25high CD127low細胞水平[(2.69±0.64)％、(2.59±0.67)％]與治療前比較差異無統計學意義.結論 新診斷ITP患者外週血Treg細胞水平低于健康對照組；地塞米鬆聯閤小劑量利妥昔單抗提升Treg細胞數量及長期療效方麵優于潑尼鬆和地塞米鬆單藥方案.
목적 관찰원발면역성혈소판감소증(ITP)환자치료전후외주혈조절성T세포(Treg)수평변화,초보탐토Treg세포재ITP발병중적작용.방법 선취138례신진단ITP환자,남57례、녀81례,중위년령40(18 ～70)세.안치료방안수궤분위①발니송조(49례):발니송1.5 mg·kg-1·d-1구복；②지새미송조(45례):지새미송40 mg/d제1～4천구복；③지새미송+소제량리타석단항조(44례):지새미송40 mg/d제1～4천구복,리타석단항100 mg제7、14、21、28천정맥적주.각조환자우치료전、치료후14 d화28 d분별채취외주정맥혈,채용류식세포술검측CD4+ CD25highCD127low세포(Treg)수평.이30명건강체검자위정상대조조.결과 치료후제28천,발니송조、지새미송조、지새미송+소제량리타석단항조적총유효솔분별위69.4％、66.7％、79.5％,차이무통계학의의；수방12개월,지새미송+소제량리타석단항조지속유효솔(66.7％)고우발니송조(37.8％)화지새미송조(22.7％),차이유통계학의의(P＜0.05),발니송여지새미송조지간차이무통계학의의.138례ITP환자치료전외주혈CD4+ CD25high CD127kw세포표체수평저우건강대조조[(1.67±0.70)％대(4.02±0.39)％,P＜0.05]；지새미송+소제량리타석단항조치료후14、28 d CD4+ CD25 highCD127low세포수평[(4.28±1.09)％、(4.44±0.63)％]균고우치료전[(1.68±0.68)％],차이유통계학의의(P치균＜0.05)；발니송조、지새미송조환자치료후14 d CD4+ CD25highCD127low세포수평균고우치료전[(3.47±0.77)％대(1.69±0.73)％、(3.23±0.78)％대(1.70±0.75)％,P치균＜0.05]；치료후28 d,발니송조、지새미송조환자CD4+ CD25high CD127low세포수평[(2.69±0.64)％、(2.59±0.67)％]여치료전비교차이무통계학의의.결론 신진단ITP환자외주혈Treg세포수평저우건강대조조；지새미송연합소제량리타석단항제승Treg세포수량급장기료효방면우우발니송화지새미송단약방안.
Objective To investigate the change of CD4+ CD25high CD127low regulatory T cells (Tregs) percentage in patients with primary immune thrombocytopenia (ITP) treated by different methods.Methods One hundred and thirty-eight newly diagnosed adult ITP patients (57 male,median age 40 years,range 18-70 years) were enrolled in this study,who were randomisedly separated into three regiment groups,namely prednisolone (PSL,1.5 mg/kg for 2-4 weeks and subsequently stepwise reduction) group enrolled 49 patients,dexamethasone [(one course of high-dose dexamethasone (HDD) 40 mg/day,dl-4] 45 patients,and rituximab plus HDD (rituximab 100 mg on days 7,14,21,28 and HDD) group 44 patients.Peripheral blood was taken in ITP patients of each group before treatment,14d and 28d after treatment.The percentages of CD4 + CD25highCD127low Tregs in 30 healthy controls and 138 patients were analyzed by flow cytometry.Results Overall response (OR) rates of PSL,HDD and R + HDD groups at day 28 were 69.4％,66.7％ and 79.5％ respectively with no difference.After the following 12 months,sustained response (SR) was more pronounced in R + HDD group compared to the other two groups (R + HDD vs PSL:66.7％ vs 37.8％,P＜0.05; R +HDD vs HDD:66.7％vs 22.7％,P＜0.05).The percentage of CD4 + CD25highCD127low Tregs in peripheral blood of ITP patients [(1.67 ± 0.70) ％] was significantly lower than in healthy control group; After treatment,the percentages of Tregs in peripheral blood of patients both at day 14 and 28 in R + HDD group remarkably decreased compared with before treatment [(4.28 ± 1.09) ％ vs (1.68 ±0.68)％,P＜0.05; (4.44 ±0.63)％ vs (1.68-±0.68)％].The percentages of Tregs at day 14in both other two groups decreased notably compared with before treatment.But the Tregs levels measured at day 28 in PSL and HDD groups were similar with before treatment.Conclusion The percentage of CD4 +CD25highCD127low Tregs in peripheral blood of ITP patients was lower than healthy individual.The higher SR of patients treated by R + HDD was related to its ability to up-regulate the percentage of CD4 + CD25high CD127low Tregs.
