CAJ | 학술논문

目的观察和评价糖皮质激素、利妥昔单抗、静脉丙种球蛋白(IVIG)对原发免疫性血小板减少症(ITP)患者B淋巴细胞抗原表达的影响.方法 71例ITP患者纳入研究,按照治疗方案分为糖皮质激素组(21例)、糖皮质激素联合利妥昔单抗组(31例)及糖皮质激素联合IVIG组(19例),以30名健康志愿者作为对照组.治疗前后测定CD19、CD20、CD80 、CD86抗原表达水平及血小板计数.结果 ①所有患者在治疗后1周内出血症状均明显好转;PLT均高于治疗前(P＜0.05),三组之间比较差异无统计学意义(P＞0.05);②三组ITP患者治疗前CD19、CD20表达水平均高于正常对照组(P＜0.05),组间比较差异无统计学意义(P＞0.05),糖皮质激素+利妥昔单抗组治疗后CD19、CD20表达水平均低于治疗前[(0.03±0.02)％对(15.96±7.72)％;(0.04±0.03)％对(15.98±7.64)％;P值均＜0.05];③三组ITP患者治疗前CD80、CD86表达水平均高于正常对照组(P＜0.05),糖皮质激素组和糖皮质激素+IVIG组治疗后CD80、CD86表达水平与治疗前比较差异无统计学意义(P＞0.05),糖皮质激素+利妥昔单抗组治疗后CD80、CD86表达水平低于治疗前[(0.06±0.12)％对(0.74±0.66)％;(0.12±0.19)％对(0.67±0.70)％;P值均＜0.05],与其他两组比较差异有统计学意义(P＜0.05).结论糖皮质激素联合利妥昔单抗可靶向清除ITP患者体内B细胞,并下调CD80、CD86表达.
목적 관찰화평개당피질격소、리타석단항、정맥병충구단백(IVIG)대원발면역성혈소판감소증(ITP)환자B림파세포항원표체적영향.방법 71례ITP환자납입연구,안조치료방안분위당피질격소조(21례)、당피질격소연합리타석단항조(31례)급당피질격소연합IVIG조(19례),이30명건강지원자작위대조조.치료전후측정CD19、CD20、CD80 、CD86항원표체수평급혈소판계수.결과 ①소유환자재치료후1주내출혈증상균명현호전;PLT균고우치료전(P＜0.05),삼조지간비교차이무통계학의의(P＞0.05);②삼조ITP환자치료전CD19、CD20표체수평균고우정상대조조(P＜0.05),조간비교차이무통계학의의(P＞0.05),당피질격소+리타석단항조치료후CD19、CD20표체수평균저우치료전[(0.03±0.02)％대(15.96±7.72)％;(0.04±0.03)％대(15.98±7.64)％;P치균＜0.05];③삼조ITP환자치료전CD80、CD86표체수평균고우정상대조조(P＜0.05),당피질격소조화당피질격소+IVIG조치료후CD80、CD86표체수평여치료전비교차이무통계학의의(P＞0.05),당피질격소+리타석단항조치료후CD80、CD86표체수평저우치료전[(0.06±0.12)％대(0.74±0.66)％;(0.12±0.19)％대(0.67±0.70)％;P치균＜0.05],여기타량조비교차이유통계학의의(P＜0.05).결론 당피질격소연합리타석단항가파향청제ITP환자체내B세포,병하조CD80、CD86표체.
Objective To observe the levels of B cell antigen expression treated by glucocorticoid,rituximab or intravenous gamma globulin for immune thrombocytopenia (ITP).Methods 71 patients with ITP were studied,including 21 cases with glucocorticoid (glucocorticoid group),31 with glucocorticoids combined rituximab (rituximab group),and 19 with glucocorticoids combined intravenous gamma globulin (gamma globulin group).30 healthy volunteers were control.Expression levels of CD 19,CD20,CD28,CD80,CD86 and platelet count were detected before and after treatment.Results ① Improvement of bleeding was seen in all cases within one week.The level of platelet count was significantly higher after administration (P ＜ 0.05),but no significant difference among three groups (P ＞ 0.05); ②In the three groups before treatment,the expression of CD19 and CD20 were higher than the control group (P ＜ 0.05).In glucocorticoid group and gamma globulin group,the expression of CD19 and CD20 was almost the same before and after treatment (P ＞ 0.05).But in rituximab group,CD19 [(0.03± 0.02)％ vs (15.96±7.72)％,P＜0.05] and CD20 [(0.04±0.03)％ vs (15.98±7.64)％,P＜0.05] were significantly lower after treatment; ③ In the three groups before treatment,the expression of CD80 and CD86 were higher than the control group (P ＜ 0.05).In glucocorticoid group and gamma globulin group,the expression decreased,but no statistical significance (P ＞ 0.05).However,the expression in rituximab group was significantly lower after treatment [CD80:(0.06±0.12)％ vs (0.74±0.66)％; CD86:(0.12± 0.19)％ vs (0.67±0.70)％; P＜ 0.05].Conclusion Low dose of rituximab combined glucocorticoid could target on CD20+ B cells and down the expression of CD80 and CD86,thus reversing the immune imbalance in ITP.