基于CD~+_4T细胞异常探讨中医药治疗免疫性血小板减少症研究进展
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摘要
免疫性血小板减少症是一种伴随T细胞免疫异常的自身免疫性疾病。细胞毒性T细胞、调节T细胞、辅助T细胞、巨核细胞成熟异常和T细胞免疫失耐受均参与ITP发病。反应性CD~+_4T细胞可增强抗血小板自身抗体的活性,促进其产生。在ITP患者体内, CD~+_4T细胞过度活化和凋亡障碍,可能导致持续的血小板破坏。目前,中医药治疗免疫性血小板减少症以取得了良好的疗效,且在调控CD~+_4T细胞亚群发挥重要作用。
Immune thrombocytopenia is an autoimmune disease with abnormal T cell immunity. Cytotoxic T cells, abnormal T regulatory cells, helper T cell imbalance, megakaryocyte maturation abnormalities and abnormal T cell anergy are involved in the pathogenesis of this condition. Reactive CD~+_4T cells enhance the activity of anti-platelet autoantibodies and promote their production. In patients with ITP, excessive activation and decreased apoptosis of CD~+_4 T cells may lead to persistent platelet destruction. At present, traditional Chinese medicine has been used for the treatment of immune thrombocytopenia to achieve a good effect, and plays an important role in the regulation of CD~+_4 T cell subsets.
Immune thrombocytopenia is an autoimmune disease with abnormal T cell immunity. Cytotoxic T cells, abnormal T regulatory cells, helper T cell imbalance, megakaryocyte maturation abnormalities and abnormal T cell anergy are involved in the pathogenesis of this condition. Reactive CD~+_4T cells enhance the activity of anti-platelet autoantibodies and promote their production. In patients with ITP, excessive activation and decreased apoptosis of CD~+_4 T cells may lead to persistent platelet destruction. At present, traditional Chinese medicine has been used for the treatment of immune thrombocytopenia to achieve a good effect, and plays an important role in the regulation of CD~+_4 T cell subsets.
引文
[1] Nishimoto T, Kuwana M. CD+4 CD+25 Foxp3+, Regulatory T Cells in the Pathophysiology of Immune Thrombocytopenia[J]. Seminars in Hematology, 2013, 50(Suppl 1):S43-S49.
[2] Ji X, Zhang L, Peng J, et al. T cell immune abnormalities in immune thrombocytopenia[J]. Journal of Hematology & Oncology, 2014, 7(1):1-6.
[3] Takahashi N, Saitoh T, Gotoh N, et al. The cytokine polymorphisms affecting Th1/Th2 increase the susceptibility to, and severity of, chronic ITP[J]. Bmc Immunology, 2017, 18(1):26-36.
[5] Shan NN, Hu Y, Hou M, et al. Decreased Tim-3 and its correlation with Th1 cells in patients with immune thrombocytopenia[J]. Thrombosis Research, 2014, 133(1):52-56.
[6] Nishimoto T, Okazaki Y, Numajiri M, et al. Mouse immune thrombocytopenia is associated with Th1 bias and expression of activating Fcγ receptors[J]. International Journal of Hematology, 2017, 105(5):598-605.
[7] Zhou SF, Ma J, Qu HT, et al. Characterization of Th1- and Th2-associated chemokine receptor expression in spleens of patients with immune thrombocytopenia[J]. Journal of Clinical Immunology, 2013, 33(5):938-946.
[8] Ye X, Zhang L, Wang H, et al. The role of IL-23/Th17 pathway in patients with primary immune thrombocytopenia[J]. Plos One, 2015, 10(1):e0117704.
[9] Zhang G, Zhang P, Liu H, et al. Assessment of Th17/Treg cells and Th cytokines in an improved immune thrombocytopenia mouse model[J]. Hematology, 2017, 22(8):493-500.
[10] Yang YY, Zhang FQ, Pan Y, et al. Quantity of Treg cells and Th17 cells in spleen of primary immune thrombocytopenic purpura patients[J]. China Medical Abstracts (Internal Medicine), 2017, 38(2):227-230.
[11] Hua F, Ji L, Zhan Y, et al. Aberrant Frequency of IL-10-Producing B Cells and Its Association with Treg/Th17 in Adult Primary Immune Thrombocytopenia Patients[J]. Biomed Research International, 2014, 2014(10):571302.
[12] 李志静. T淋巴细胞亚群(CD+4,CD+8,CD+4/CD+8)与免疫性血小板减少性紫癜中医证型相关性研究[J]. 实用中医内科杂志, 2014,6(28):10-12.
[13] 刘清池, 高习华, 王淑珍,等. 凉血解毒法对免疫性血小板减少症患者T淋巴细胞亚群的调节作用[J]. 河北中医, 2013, 35(5):652-654.
[14] 陆泳萍. 养血和血方治疗免疫性血小板减少性紫癜的疗效研究及对细胞因子、血小板参数的影响[J]. 河北中医药学报, 2016, 31(1):48-51.
[15] 刘现辉, 郭晓娜. 补气消癜汤对免疫性血小板减少症模型小鼠的白细胞介素系列因子及TNF-α的影响[J]. 中华中医药学刊, 2017(1):196-199.
[16] 吴晓勇, 李冬云, 陈信义,等. 益髓颗粒对免疫性血小板减少性紫癜模型小鼠细胞相关因子表达影响[J]. 中华中医药杂志, 2010(6):849-852.
[17] 李欣红. 升板止血汤治疗慢性血小板减少性紫癜患者临床疗效分析[J]. 河北中医药学报, 2017, 32(4):25-29.
[18] 周延峰, 马然, 郑洪敏. 益气消癍汤治疗特发性血小板减少性紫癜实验研究[J]. 成都中医药大学学报, 2011, 34(2):71-74.
[19] 冯晓燕, 杨长福, 施建南,等. 加味四物汤对血小板减少性紫癜模型小鼠IL-2影响的实验研究[J]. 时珍国医国药, 2013, 24(8):1867-1868.
[20] 宫深谋. 仙连颗粒对ITP患者血清IL-11、sIL-2R的影响及临床疗效观察[D]. 郑州:河南中医学院, 2008.
[21] Atesoglu EB, Tarkun P, Demirsoy ET, et al. Soluble Programmed Death 1 (PD-1) Is Decreased in Patients With Immune Thrombocytopenia (ITP): Potential Involvement of PD-1 Pathway in ITP Immunopathogenesis[J]. Clinical & Applied Thrombosis/hemostasis Official Journal of the International Academy of Clinical & Applied Thrombosis/hemostasis, 2014, 22(3):248-251.
[22] 解国品. 疏风凉血补肾法干预下CITP患者PD-1/PD-L变化规律的研究[D]. 广州:广州中医药大学, 2013.
[23] 李杨, 孙丽, 林庶如. 四类中药组方对血小板减少性紫癜模型小鼠PAIgG及外周血PD-1表达的影响[J]. 中华中医药学刊, 2017,35(10):2646-2650.
[24] 冯龙, 赵国强, 马云云,等. 穿心莲对人外周血CD+4T淋巴细胞表面CXCR4和CCR5的影响以及对CXCR4/CCR5启动子作用机制的研究[J]. 中国中药杂志, 2011, 36(21):3012-3017.
[25] 张宇, 钱丽丽, 陈颖,等. 益气滋阴方对免疫性血小板减少症患者外周血Treg及Foxp3影响的临床观察[J]. 浙江中医药大学学报, 2017(3):215-218.
[26] 侯文沛. 三七升板汤治疗免疫性血小板减少症的临床疗效与安全性研究[D]. 上海:上海中医药大学, 2016.
[27] 全日城. 参桂益气温阳汤治疗CITP临床、相关免疫学及转录因子研究[D]. 北京:中国中医科学院, 2010.
[28] 张雪娟, 王春秀, 赵伟娥,等. 芪桂升板方对慢性免疫性血小板减少症患者血小板抗体和调节性T细胞的影响[J]. 中国中医基础医学杂志, 2014(3):353-354.
[29] 何牧卿, 何牧群, 郭文坚. 升血小板胶囊对免疫性血小板减少性紫癜CD+4CD+25Treg细胞的影响[J]. 中华中医药学刊, 2015,33(2):422-425.
[30] 尹艳, 王若晖, 郝晶,等. 桑椹三仙胶治疗慢性特发性血小板减少性紫癜患者前后调节性T细胞及GITR表达的变化[J]. 中医药学报, 2011, 39(4):58-60.
[31] 高飏, 蒋祖军. 羊蹄根对免疫性血小板减少性紫癜模型小鼠转化生长因子-β1及其受体的影响[J]. 河北医学, 2017, 23(5):741-744.
[32] 王潇. Th17细胞在特发性血小板减少性紫癜发病中的作用及肿节风对其影响的研究[D]. 杭州:浙江中医药大学, 2013.
[33] Kimura A, Kishimoto T. IL-6: regulator of Treg/Th17 balance.[J]. European Journal of Immunology, 2010, 40(7):1830-1835.
[34] 郝颖, 初杰, 范颖. 紫癜康颗粒对免疫性血小板减少性紫癜模型小鼠多个细胞因子的影响[J]. 中华中医药学刊, 2017,35(7):1705-1707.
[35] 向琪, 杨方方, 王顺清,等. 升血小板胶囊联合泼尼松对原发免疫性血小板减少症患者 Treg 细胞和Th17细胞的影响[J]. 血栓与止血学, 2015(6):360-363.
[36] 郑雪倩, 周韶虹, 屠仁枫,等. Treg/Th17与免疫性血小板减少症中医证型的相关性[J]. 第二军医大学学报, 2015, 36(11):1254-1258.
[4] ?ulic'S,Salamunic'I,Konjevoda P,et al. Immune thrombocytopenia:serum cytokine levels in children and adults[J]. Medical Science Monitor International Medical Journal of Experimental&Clinical Research,2013,19(1):797-801.
[2] Ji X, Zhang L, Peng J, et al. T cell immune abnormalities in immune thrombocytopenia[J]. Journal of Hematology & Oncology, 2014, 7(1):1-6.
[3] Takahashi N, Saitoh T, Gotoh N, et al. The cytokine polymorphisms affecting Th1/Th2 increase the susceptibility to, and severity of, chronic ITP[J]. Bmc Immunology, 2017, 18(1):26-36.
[5] Shan NN, Hu Y, Hou M, et al. Decreased Tim-3 and its correlation with Th1 cells in patients with immune thrombocytopenia[J]. Thrombosis Research, 2014, 133(1):52-56.
[6] Nishimoto T, Okazaki Y, Numajiri M, et al. Mouse immune thrombocytopenia is associated with Th1 bias and expression of activating Fcγ receptors[J]. International Journal of Hematology, 2017, 105(5):598-605.
[7] Zhou SF, Ma J, Qu HT, et al. Characterization of Th1- and Th2-associated chemokine receptor expression in spleens of patients with immune thrombocytopenia[J]. Journal of Clinical Immunology, 2013, 33(5):938-946.
[8] Ye X, Zhang L, Wang H, et al. The role of IL-23/Th17 pathway in patients with primary immune thrombocytopenia[J]. Plos One, 2015, 10(1):e0117704.
[9] Zhang G, Zhang P, Liu H, et al. Assessment of Th17/Treg cells and Th cytokines in an improved immune thrombocytopenia mouse model[J]. Hematology, 2017, 22(8):493-500.
[10] Yang YY, Zhang FQ, Pan Y, et al. Quantity of Treg cells and Th17 cells in spleen of primary immune thrombocytopenic purpura patients[J]. China Medical Abstracts (Internal Medicine), 2017, 38(2):227-230.
[11] Hua F, Ji L, Zhan Y, et al. Aberrant Frequency of IL-10-Producing B Cells and Its Association with Treg/Th17 in Adult Primary Immune Thrombocytopenia Patients[J]. Biomed Research International, 2014, 2014(10):571302.
[12] 李志静. T淋巴细胞亚群(CD+4,CD+8,CD+4/CD+8)与免疫性血小板减少性紫癜中医证型相关性研究[J]. 实用中医内科杂志, 2014,6(28):10-12.
[13] 刘清池, 高习华, 王淑珍,等. 凉血解毒法对免疫性血小板减少症患者T淋巴细胞亚群的调节作用[J]. 河北中医, 2013, 35(5):652-654.
[14] 陆泳萍. 养血和血方治疗免疫性血小板减少性紫癜的疗效研究及对细胞因子、血小板参数的影响[J]. 河北中医药学报, 2016, 31(1):48-51.
[15] 刘现辉, 郭晓娜. 补气消癜汤对免疫性血小板减少症模型小鼠的白细胞介素系列因子及TNF-α的影响[J]. 中华中医药学刊, 2017(1):196-199.
[16] 吴晓勇, 李冬云, 陈信义,等. 益髓颗粒对免疫性血小板减少性紫癜模型小鼠细胞相关因子表达影响[J]. 中华中医药杂志, 2010(6):849-852.
[17] 李欣红. 升板止血汤治疗慢性血小板减少性紫癜患者临床疗效分析[J]. 河北中医药学报, 2017, 32(4):25-29.
[18] 周延峰, 马然, 郑洪敏. 益气消癍汤治疗特发性血小板减少性紫癜实验研究[J]. 成都中医药大学学报, 2011, 34(2):71-74.
[19] 冯晓燕, 杨长福, 施建南,等. 加味四物汤对血小板减少性紫癜模型小鼠IL-2影响的实验研究[J]. 时珍国医国药, 2013, 24(8):1867-1868.
[20] 宫深谋. 仙连颗粒对ITP患者血清IL-11、sIL-2R的影响及临床疗效观察[D]. 郑州:河南中医学院, 2008.
[21] Atesoglu EB, Tarkun P, Demirsoy ET, et al. Soluble Programmed Death 1 (PD-1) Is Decreased in Patients With Immune Thrombocytopenia (ITP): Potential Involvement of PD-1 Pathway in ITP Immunopathogenesis[J]. Clinical & Applied Thrombosis/hemostasis Official Journal of the International Academy of Clinical & Applied Thrombosis/hemostasis, 2014, 22(3):248-251.
[22] 解国品. 疏风凉血补肾法干预下CITP患者PD-1/PD-L变化规律的研究[D]. 广州:广州中医药大学, 2013.
[23] 李杨, 孙丽, 林庶如. 四类中药组方对血小板减少性紫癜模型小鼠PAIgG及外周血PD-1表达的影响[J]. 中华中医药学刊, 2017,35(10):2646-2650.
[24] 冯龙, 赵国强, 马云云,等. 穿心莲对人外周血CD+4T淋巴细胞表面CXCR4和CCR5的影响以及对CXCR4/CCR5启动子作用机制的研究[J]. 中国中药杂志, 2011, 36(21):3012-3017.
[25] 张宇, 钱丽丽, 陈颖,等. 益气滋阴方对免疫性血小板减少症患者外周血Treg及Foxp3影响的临床观察[J]. 浙江中医药大学学报, 2017(3):215-218.
[26] 侯文沛. 三七升板汤治疗免疫性血小板减少症的临床疗效与安全性研究[D]. 上海:上海中医药大学, 2016.
[27] 全日城. 参桂益气温阳汤治疗CITP临床、相关免疫学及转录因子研究[D]. 北京:中国中医科学院, 2010.
[28] 张雪娟, 王春秀, 赵伟娥,等. 芪桂升板方对慢性免疫性血小板减少症患者血小板抗体和调节性T细胞的影响[J]. 中国中医基础医学杂志, 2014(3):353-354.
[29] 何牧卿, 何牧群, 郭文坚. 升血小板胶囊对免疫性血小板减少性紫癜CD+4CD+25Treg细胞的影响[J]. 中华中医药学刊, 2015,33(2):422-425.
[30] 尹艳, 王若晖, 郝晶,等. 桑椹三仙胶治疗慢性特发性血小板减少性紫癜患者前后调节性T细胞及GITR表达的变化[J]. 中医药学报, 2011, 39(4):58-60.
[31] 高飏, 蒋祖军. 羊蹄根对免疫性血小板减少性紫癜模型小鼠转化生长因子-β1及其受体的影响[J]. 河北医学, 2017, 23(5):741-744.
[32] 王潇. Th17细胞在特发性血小板减少性紫癜发病中的作用及肿节风对其影响的研究[D]. 杭州:浙江中医药大学, 2013.
[33] Kimura A, Kishimoto T. IL-6: regulator of Treg/Th17 balance.[J]. European Journal of Immunology, 2010, 40(7):1830-1835.
[34] 郝颖, 初杰, 范颖. 紫癜康颗粒对免疫性血小板减少性紫癜模型小鼠多个细胞因子的影响[J]. 中华中医药学刊, 2017,35(7):1705-1707.
[35] 向琪, 杨方方, 王顺清,等. 升血小板胶囊联合泼尼松对原发免疫性血小板减少症患者 Treg 细胞和Th17细胞的影响[J]. 血栓与止血学, 2015(6):360-363.
[36] 郑雪倩, 周韶虹, 屠仁枫,等. Treg/Th17与免疫性血小板减少症中医证型的相关性[J]. 第二军医大学学报, 2015, 36(11):1254-1258.
[4] ?ulic'S,Salamunic'I,Konjevoda P,et al. Immune thrombocytopenia:serum cytokine levels in children and adults[J]. Medical Science Monitor International Medical Journal of Experimental&Clinical Research,2013,19(1):797-801.