外周血Th17细胞对大剂量地塞米松治疗免疫性血小板减少症长期疗效的预测价值
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摘要
目的评价免疫性血小板减少症(ITP)病人外周血Th17细胞比例对大剂量地塞米松(DXM)长期疗效的预测价值。方法采用流式细胞术检测42例初诊ITP病人外周血Th17细胞比例,分析Th17细胞比例在持续反应组病人(15例)及复发组(18例)病人之间的差异,应用受试者工作曲线法(ROC)分析Th17细胞比例对大剂量DXM长期疗效的预测价值。结果复发组病人治疗前外周血Th17细胞比例显著高于持续反应组病人(P<0.01)。应用治疗前外周血Th17细胞比例预测大剂量DXM的长期疗效,其曲线下面积为0.857(95%CI:0.717～0.998,P<0.01),cut-off值为1.235%。结论初诊外周血Th17细胞比例有助于预测大剂量DXM在ITP的长期疗效。
Objective To assess the value of Th17 cells on predicting long-term efficacy of high-dose dexamethasone(DXM) in the treatment of patients with immune thrombocytopenia(ITP).Methods Flow cytometry was used to detect Th17 cells in 42 newly-diagnosed ITP patients,and the difference of Th17 ratios was compared between sustained responders and relapsed patients.The predictive efficiency of Th17 cells on long-term efficacy of high-dose DXM was evaluated by receiver operating characteristics(ROC) curve analysis.Results The ratio of Th17 cells at diagnosis in relapsed ITP patients was significantly higher than that in sustained responders(P<0.01).When long-term efficacy of high-dose DXM was evaluated by ROC curve analysis,the area under curve was 0.857(95% CI:0.717-0.998,P<0.01),cut-off value of Th17 cells ratio was 1.235%.Conclusion Ratios of Th17 cells in peripheral blood at diagnosis were useful for predicting the long-term efficacy of high-dose DXM in ITP patients.
Objective To assess the value of Th17 cells on predicting long-term efficacy of high-dose dexamethasone(DXM) in the treatment of patients with immune thrombocytopenia(ITP).Methods Flow cytometry was used to detect Th17 cells in 42 newly-diagnosed ITP patients,and the difference of Th17 ratios was compared between sustained responders and relapsed patients.The predictive efficiency of Th17 cells on long-term efficacy of high-dose DXM was evaluated by receiver operating characteristics(ROC) curve analysis.Results The ratio of Th17 cells at diagnosis in relapsed ITP patients was significantly higher than that in sustained responders(P<0.01).When long-term efficacy of high-dose DXM was evaluated by ROC curve analysis,the area under curve was 0.857(95% CI:0.717-0.998,P<0.01),cut-off value of Th17 cells ratio was 1.235%.Conclusion Ratios of Th17 cells in peripheral blood at diagnosis were useful for predicting the long-term efficacy of high-dose DXM in ITP patients.
引文
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[12] LI J,WANG Z,HU S,et al.Correction of abnormal T cell subsets by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura [J].Immunol Lett,2013,154(1-2):42-48.
[2] 侯明,秦平.成人原发免疫性血小板减少症诊治的中国专家共识(2016版)解[J].临床血液学杂志,2016,29 (7):523-527.
[3] CHENG Y,WONG RS,SOO YO,et al.Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone [J].N Engl J Med,2013,349 (9):831-836.
[4] WEI Y,JI XB,WANG YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial[J].Blood,2016,127(3):296-302.
[5] ZHOU L,XU F,CHANG C,TAO Y,et al.Interleukin-17-producing CD4+ T lymphocytes are increased in patients with primary immune thrombocytopenia [J].Blood Coagul Fibrinolysis,2016,27(3):301-307.
[6] JI L,ZHAN Y,HUA F,et al.The ratio of Treg/Th17 cells correlates with the disease activity of primary immune thrombocytopenia [J].PLoS One,2012,7(12):e50909.DOI:10.1371/journal.pone.0050909.
[7] 王潇,周郁鸿,陈小红,等.Th17细胞在特发性血小板减少性紫癜发病中的作用和意义 [J].中国实验血液学杂志,2016,24 (6):1833-1836.
[8] MCKENZIE CG,GUO L,FREEDMAN J,et al.Cellular immune dysfunction in immune thrombocytopenia (ITP) [J].Br J Haematol,2013,163(1):10-23.
[9] KUWABARA T,ISHIKAWA F,KONDO M,et al.The role of IL-17 and related cytokines in inflammatory autoimmune diseases[J].Mediators Inflamm,2017:3908061.DOI:10.1155/2017/3908061.
[10] 张玉萍,姚茹冰,赵智明,等.IL-17在类风湿关节炎中的研究进展 [J].安徽医药,2016,20(3):580-582.
[11] YOH K,MORITO N,OJIMA M,et al.Overexpression of RORγt under control of the CD2 promoter induces polyclonal plasmacytosis and autoantibody production in transgenic mice[J].Eur J Immunol,2012,42(8):1999-2009.
[12] LI J,WANG Z,HU S,et al.Correction of abnormal T cell subsets by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura [J].Immunol Lett,2013,154(1-2):42-48.