外周血自然杀伤细胞比例在原发免疫性血小板减少症中临床意义

申星; 程芳芳; 常舒婷; 赵丽东; 呼小茹; 杨林花

doi:10.13201/j.issn.1004-2806.2019.01.013

外周血自然杀伤细胞比例在原发免疫性血小板减少症中临床意义

- 山西医科大学第二医院血液科(太原, 030001)

详细信息

通讯作者: 杨林花,E-mail:yanglh5282@163.com

中图分类号: R554.1

收稿日期: 2018-11-26

Clinical significance of peripheral blood NK cell ratio in primary immune thrombocytopenia

- Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, China

More Information

Corresponding author: YANG Linhua, E-mail: yanglh5282@163.com

Received Date: 26 November 2018

摘要

摘要: 目的:探讨原发免疫性血小板减少症(ITP)患者初诊时外周血淋巴细胞亚群中自然杀伤(NK)细胞比例在ITP中的临床意义。方法:收集149例初诊ITP患者的临床资料,依据NK细胞比例分为NK细胞比例降低组(89例)、正常组(56例)及升高组(4例),分别记录3组患者年龄、性别、血小板计数、淋巴细胞数、治疗前辅助性T细胞(Th细胞)、抑制性T细胞(Ts细胞)、NK细胞、CD19⁺细胞比例及出血评分,比较各组患者临床特点。总结各组患者治疗起效时间、完全反应时间及复发时间,比较不同组别的疗效及预后。结果:①3组患者治疗前血小板计数、淋巴细胞数、Th细胞、Ts细胞、CD19⁺细胞百分比均差异无统计学意义(均P>0.05)。分别个体化给予不同治疗方案,中位随访时间为5(2~60)个月,3组患者临床疗效比较均差异无统计学意义(均P>0.05)。②年龄与治疗前Th细胞比例、出血评分存在正相关关系(r=0.175、0.206),Ts细胞比例与Th细胞、NK细胞及CD19⁺细胞比例呈负相关(r=-0.501、-0.247、-0.355)。结论:NK细胞比例降低与ITP的发病有一定相关性,老年患者出血风险更高。检测外周血NK细胞比例对临床上ITP的诊治具有重要指导意义。
- 原发免疫性血小板减少症 /
- NK细胞 /
- 临床意义
Abstract: Objective:To investigate the clinical significance of the proportion of natural killer (NK) cells in peripheral blood lymphocyte subsets in patients with primary immune thrombocytopenia (ITP) at the initial diagnosis.Method:The clinical data of 149 initial diagnosed patients with ITP were collected.According to the proportion of NK cells,the patients were divided into three groups:NK cell reduction group (n=89),normal group (n=56) and elevated group (n=4).Age,sex,platelet count,lymphocyte count,helper T cell (Th cell),suppressor T cell (Ts cell),NK cell,CD19⁺ cell ratio and bleeding score were recorded before treatment in each group.The clinical characteristics of the three groups were compared.We summarized the onset time,complete response time and recurrence time of treatment in each group,and compared the curative effect and prognosis of different groups.Result:①There was no significant difference in platelet count,lymphocyte count,Th cell,Ts cell and CD19⁺ cell percentage among the three groups before treatment (P>0.05).Individualized treatment options were given individually.The median follow-up time was 5 (2 to 60) months.There was no significant difference in clinical efficacy between the three groups (P>0.05).②There was a weak positive correlation between age and the proportion of Th cells and the score of bleeding before treatment (r=0.175,0.206).The proportion of Ts cell was negatively correlated with the proportion of Th cell,NK cell and CD19⁺ cell (r=-0.501,-0.247,-0.355).Conclusion:Decreased NK cell ratio is associated with the onset of ITP.Elderly patients may have a higher risk of bleeding.The ratio of NK cell in peripheral blood has important guiding significance for the diagnosis and treatment in ITP in clinic.
- primary immune thrombocytopenia /
- natural killer cell /
- clinical significance

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参考文献(20)

[1]	Kashiwagi H, Tomiyama Y.Pathophysiology and management of primary immune thrombocytopenia[J].Int J Hematol, 2013, 98:24-33.
[2]	Cines DB, Bussel JB, Liebman HA, et al.The ITP syndrome:pathogenic and clinical diversity[J].Blood, 2009, 113:6511-6521.
[3]	Olsson B, Andersson PO, Jernas M, et al.T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura[J].Nat Med, 2003, 9:1123-1124.
[4]	Mckenzie CG, Guo L, Freedman J, et al.Cellular immune dysfunction in immune thrombocytopenia (ITP)[J].Br J Haematol, 2013, 163:10-23.
[5]	Yang L, Wang L, Zhao C, et al.Contributions of TRAIL-mediated megakaryocyte apoptosis to impaired megakaryocyte and platelet production in immune thrombocytopenia[J].Blood, 2010, 116:4307-4316.
[6]	Park YW, Kee SJ, Cho YN, et al.Impaired differentiation and cytotoxicity of natural killer cells in systemic lupus erythematosus[J].Arthritis Rheumatol, 2009, 60:1753-1763.
[7]	Leavenworth JW, Wang X, Wenander CS, et al.Mobilization of natural killer cells inhibits development of collagen-induced arthritis[J].Proc Natl Acad Sci U S A, 2011, 108:14584-14589.
[8]	Liu C, Li Z, Sheng W, et al.Abnormalities of quantities and functions of natural killer cells in severe aplastic anemia[J].Immunol Invest, 2014, 43:491-503.
[9]	Zhang Y, Lv G, Lou X, et al.NKG2A expression and impaired function of NK cells in patients with new onset of Graves'disease[J].Int Immunopharmacol, 2015, 24:133-139.
[10]	Zhao Z, Yang L, Yang G, et al.Contributions of T lymphocyte abnormalities to therapeutic outcomes in newly diagnosed patients with immune thrombocytopenia[J].PLos One, 2015, 10:e0126601.
[11]	Talaat RM, Elmaghraby AM, Barakat SS, et al.Alterations in immune cell subsets and their cytokine secretion profile in childhood idiopathic thrumbocytopenic purpura (ITP)[J].Clin Exp Imnmnol, 2014, 176:291-300.
[12]	Ebbo M, Audonnet S, Grados A, et al.NK cell compartment in the peripheral blood and spleen in adult patients with primary immune thrombocytopenia[J].Clin Immunol, 2017, 177:18-28.
[13]	Provan D, Stasi R, Newland AC, et al.International consensus report on the investigation and management of primary immune thrombocytopenia[J].Blood, 2010, 115:168-186.
[14]	Liu XG, Hou M.Immune thrombocytopenia and Bcell-activating factor/a proliferation-inducing ligand[J].Semin Hematol, 2013, 50:89-99.
[15]	Zhou Z, Li X, Li J, et al.Direct B-cell stimulation by peripheral blood monocyte-derived dendritic cells in idiopathic thrombocytopenic purpura patients[J].J Clin Immunol, 2010, 30:814-822.
[16]	Stasi R.Immune thmmbocytopenia:pathophysiologic and clinical update[J].Semin Thromb Hemost, 2012, 38:454-462.
[17]	Yu J, Freud AG, Caligiuri MA.Location and cellular stages of natural killer cell development[J].Trends Immunol, 2013, 34:573-573.
[18]	Tian Z, Gershwin ME, Zhang C.Regulatory NK cells in autoimmune disease[J].J Autoimmun, 2012, 39:206-215.
[19]	王明镜, 胡晓梅, 邓中阳, 等.免疫性血小板减少症的免疫机制研究进展[J].临床血液学杂志, 2017, 30 (9):725-728.
[20]	张玉娇, 瞿文, 刘惠, 等.免疫性血小板减少症患者NK细胞数量及功能[J].中华医学杂志, 2017, 97 (16):1231-1235.