CAJ | 학술논문

目的探讨利妥昔单抗(RTX)治疗无效的难治性原发免疫性血小板减少症(ITP)的可能原因.方法以2008至2013年郑州大学第二附属医院血液科收治的20例难治性ITP和同期10名健康自愿者为研究对象,采用流式细胞术(FCM)检测外周血记忆T淋巴细胞(Tm) (CI4+CD45RO+)、CD19+ CD20+B淋巴细胞,ELISA法检测外周血血小板相关抗体(PAIgG/IgM).结果 (1)20例难治性ITP患者应用RTX治疗后,12例有效,8例无效.RTX无效组难治性ITP患者在RTX治疗前、治疗后其外周血CD4+ CI45RO+ Tm水平(41.33％±9.62％、45.36％±8.57％),均显著高于RTX有效组(22.36％±11.57％、26.65％±6.32％)及健康对照组(19.72％±7.35％、20.64％±7.35％)(均P＜0.05);RTX有效组和健康对照组差异无统计学意义(均P＞0.05).RTX有效组和无效组患者的外周血CD4+ CD45RO+ Tm水平,RTX治疗前与治疗后比较差异均无统计学意义(均P＞0.05).(2)RTX治疗前,RTX无效组患者外周血CD19+ CD20+B淋巴细胞水平显著低于RTX有效组[16.36％ (6.17％～27.53％)比45.72％(35.80％～57.19％),P＜0.05];治疗后,RTX无效组和有效组差异无统计学意义[6.67％(4.09％～19.17％)比5.19％ (3.78％～17.39％),P＞0.05].RTX有效组及无效组患者的外周血CD19+ CD20+B淋巴细胞,RTX治疗后较治疗前均显著减低(均P＜0.05).(3)RTX无效组患者,在RTX治疗前、后均未检测到PAIgG/IgM;RTX有效组12例患者中,治疗前11例检测出PAIgG/IgM,治疗后仅1例检测出PAIgG/IgM.结论 RTX治疗无效的难治性ITP可能与CD4+ CD45RO+ Tm相关,与B淋巴细胞及自身抗体无关.
목적 탐토리타석단항(RTX)치료무효적난치성원발면역성혈소판감소증(ITP)적가능원인.방법 이2008지2013년정주대학제이부속의원혈액과수치적20례난치성ITP화동기10명건강자원자위연구대상,채용류식세포술(FCM)검측외주혈기억T림파세포(Tm) (CI4+CD45RO+)、CD19+ CD20+B림파세포,ELISA법검측외주혈혈소판상관항체(PAIgG/IgM).결과 (1)20례난치성ITP환자응용RTX치료후,12례유효,8례무효.RTX무효조난치성ITP환자재RTX치료전、치료후기외주혈CD4+ CI45RO+ Tm수평(41.33％±9.62％、45.36％±8.57％),균현저고우RTX유효조(22.36％±11.57％、26.65％±6.32％)급건강대조조(19.72％±7.35％、20.64％±7.35％)(균P＜0.05);RTX유효조화건강대조조차이무통계학의의(균P＞0.05).RTX유효조화무효조환자적외주혈CD4+ CD45RO+ Tm수평,RTX치료전여치료후비교차이균무통계학의의(균P＞0.05).(2)RTX치료전,RTX무효조환자외주혈CD19+ CD20+B림파세포수평현저저우RTX유효조[16.36％ (6.17％～27.53％)비45.72％(35.80％～57.19％),P＜0.05];치료후,RTX무효조화유효조차이무통계학의의[6.67％(4.09％～19.17％)비5.19％ (3.78％～17.39％),P＞0.05].RTX유효조급무효조환자적외주혈CD19+ CD20+B림파세포,RTX치료후교치료전균현저감저(균P＜0.05).(3)RTX무효조환자,재RTX치료전、후균미검측도PAIgG/IgM;RTX유효조12례환자중,치료전11례검측출PAIgG/IgM,치료후부1례검측출PAIgG/IgM.결론 RTX치료무효적난치성ITP가능여CD4+ CD45RO+ Tm상관,여B림파세포급자신항체무관.
Objective To explore the possible causes for an absence of response to rituximab (RTX) in patients with refractory immune thrombocytopenia (ITP).Methods A total of 20 refractory ITP patients on RTX therapy and 10 health volunteers were recruited from 2008 to 2013.Memory T lymphocytes (Tm) (CD4+CD45RO+) and B lymphocytes (CD19+ CD20+) in peripheral blood (PB) were examined by flow cytometry (FCM).And enzyme-linked immunosorbent assay (ELISA) was employed for detecting the platelet-associated antibodies IgG/IgM (PAIgG/IgM).Results (1) 12 patients with refractory ITP achieved a good response after therapy with RTX (effective RTX group) and 8 cases failed to respond (ineffective RTX group).The PB levels of CD4+ CD45RO + Tm were 41.33％ ± 9.62％ and 45.36％ ± 8.57％ respectively at pre-therapy and post-therapy in ineffective RTX group.And significant differences existed between ineffective and effective RTX groups(22.36％ ± 11.57％,26.65％ ±6.32％)versus health volunteers (19.72％ ±7.35％,20.64％ ±7.35％) (all P ＜0.05).No statistical differences existed in the PB level of CD4 + CD45RO + Tm between pre-therapy and post-therapy in ineffective or effective RTX group (both P ＞ 0.05) ; (2) The PB level of CD19 + CD20 + B lymphocytes in RTX ineffective group was lower than that at pre-therapy in RTX effective group (16.36％ (6.17％-27.53％) vs 45.72％ (35.80％-57.19％),P ＜0.05).No significant difference existed in the level of CD19+CD20+B at post-therapy between ineffective and effective RTX groups (6.67％ (4.09％-19.17％) vs 5.19％ (3.78％-17.39％),P ＞ 0.05).And significant differences existed in the PB level of CD19+ CD20+B between pretherapy and post-therapy in ineffective or effective RTX group (both P ＞ 0.05) ; (3) PAIgG/IgM was not detected in RTX ineffective group.And PAIgG/IgM was found in 11 cases at pre-therapy versus 1 case at post-therapy in RTX effective group.Conclusion CD4+ CD45RO+Tm is probably associated with an absence of response to RTX in patients with refractory ITP.