摘要
目的研究慢性特发性血小板减少性紫癜(CITP)患者外周血CD4+CXCR5+FoxP3-ICOS+T(Tfh)、CD4+CXCR5+FoxP3+ICOS+T(Tfr)细胞比例及转录因子Bcl-6/Blimp-1的变化,并探讨其与CITP患者血小板自身抗体阳性率之间的关系及临床意义。方法收集2016年2月-2018年3月确诊的CITP患者,随机选取30例作为病例组,同时选择30名健康人群作为对照组,分别采集病例组与对照组外周静脉血并分离单核细胞,采用流式细胞术(FCM)检测Tfh/Tfr细胞亚群的数量与比例,免疫组化法测定外周血单核细胞Bcl-6/Blimp-1蛋白表达水平,并分析Tfh/Tfr、Bcl-6/Blimp-1比值变化与血小板自身抗体阳性率之间的关系。结果与对照组比较,CITP组外周血Tfh细胞、Tfh/Tfr比值均升高,而Tfr细胞比例降低,差异均有统计学意义(P<0.05)。与对照组比较,CITP组外周血单核细胞转录因子Bcl-6表达和Bcl-6/Blimp-1比值升高,而转录因子Blimp-1表达降低,差异均有统计学意义(P<0.05)。相关性分析表明Tfh/Tfr、Bcl-6/Blimp-1比例变化与CITP患者外周血血小板自身抗体阳性率呈正相关(P<0.05),Tfr、Blimp-1的变化与血小板抗体阳性率呈负相关(P<0.05)。结论 Tfh/Tfr细胞及转录因子Bcl-6/Blimp-1平衡可能与CITP患者自身血小板抗体紊乱密切相关,该研究可为CITP的临床诊断与治疗提供新的靶点与思路,具有重要的临床意义。
Objective To study the peripheral blood CD4+CXCR5+FoxP3-ICOS+T(Tfh),CD4+CXCR5+FoxP3+ICOS+T(Tfr)subsets and related factor Bcl-6/Blimp-1 changes in patients with chronic idiopathic thrombocytopenic purpura(CITP),and explore their significances. Methods The rates of CD4+CXCR5+FoxP3-ICOS+T(Tfh),CD4+CXCR5+FoxP3+ICOS+T(Tfr)subsets of the peripheral blood from 30 patients with CITP and 30 healthy controls were analyzed by flow cytometry with immunofluorescent staining. The levels of the peripheral blood Bcl-6/Blimp-1 were detected by immunohistochemical method,the ratios of Bcl-6/Blimp-1 and Tfh/Tfr were analyzed,and the relationships between the Tfh/Tfr,Bcl-6/Blimp-1 ratios and PAIgG positive rates were studied. Results The numbers of peripheral blood Tfh were significantly increased in patients with CITP in comparison with those of healthy controls(P<0.05),but the Tfr subsets were lower than those of controls. The ratios of Tfh/Tfr and Bcl-6/Blimp-1 were significantly higher than those of controls(P<0.05),but the ratios of Tfr and Blimp-1 decreased compared with those of healthy controls(P<0.05). Besides,there were positive relations between the ratios of Tfh/Tfr,Bcl-6/Blimp-1 and PAIgG positive rates(P<0.05),but there were negative relationship between the ratio of Tfr,Blimp-1 and PAIgG positive rates(P<0.05). Conclusion The disorder of Tfh/Tfr subsets in peripheral blood of CITP and the changes of Tfh/Tfr and Bcl-6/Blimp-1 ratios might play an important role in the immune pathogenesis of CITP,and provide a new way for CITP clinical diagnose and treatment.
引文
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