免疫性血小板减少症妊娠期发病机制研究
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摘要
目的探讨免疫性血小板减少症(primary immune thrombocytopenia,ITP)妊娠期发病机制中免疫调节细胞的作用。方法选取2013年6月至2017年12月于北京大学人民医院分娩的ITP病例39例为实验组,妊娠期血小板减少症(GT)40例为患病对照组,以同期正常孕妇40例为正常对照组。应用实时定量PCR检测并比较各组外周静脉血中调节性T细胞(CD4+CD25+Treg)特异性基因Foxp3与树突状细胞(DCs)特异性基因TLR4的表达数量,及二者与相应细胞的数量关系。结果 (1) Foxp3的相对表达量在ITP组较正常对照组显著降低,差异有统计学意义(P <0.05);Foxp3表达量的降低与血小板降低程度相符;Foxp3表达量变化和CD4+CD25+Treg细胞数量差异趋势相符;(2) ITP组与GT组TLR4的相对表达量均较正常对照组降低,ITP组降低更为显著,差异均有统计学意义(P <0.05)。ITP组与GT组比较,差异无统计学意义(P>0.05)。TLR4表达量变化和DC总细胞数量减少趋势相符。结论在妊娠期ITP中Foxp3与TLR4表达均降低,与CD4+CD25+Treg与DCs数量降低趋势相符,二者在ITP妊娠期发病机制中起作用,可作为临床对ITP患者妊娠期病情进展的监测指标。
Objective To investigate the function of immune regulate cells in the pathogenesis of primary immune thrombocytopenia(ITP) in pregnancy. Methods 39 cases of perinatal pregnant women with ITP who admitted to Peking University People's Hospital from June 2013 to December 2017, were selected as the experimental group(ITP group). 40 cases of gestational thrombocy to penia(GT) and 40 cases of normal pregnant women who were the same in age and gestational week, were selected as comparative and normal control group correspondingly. The expressions of specific gene Foxp3 of CD4+CD25+Treg cells and TLR4 of DCs in the peripheral blood were measured and compared by real-time PCR. Results(1)Compared with normal control group, the expressions of Foxp3 in ITP group and GT group were both reduced, with statistical differences(P < 0.05). The reduction of Foxp3 were consistent with the reduce of CD4+CD25+Treg cells and PLT counts.(2)The expressions of TLR4 in ITP group and GT group were both reduced with statistical differences(P < 0.05). There is no statistical difference between ITP and GT. The reduction degree of TLR4 were consistent with the reduce of DCs and PLT counts. Conclusions The expression of Foxp3 and TLR4 were both reduced in gestational ITP patients, and the reduce tendency were consistent with the reduce of CD4+CD25+Treg and DCs correspondingly. The interaction play a role in the pathogenesis of ITP during pregnancy, and both can be used as clinical monitoring indicators in pregnancy patients with ITP.
Objective To investigate the function of immune regulate cells in the pathogenesis of primary immune thrombocytopenia(ITP) in pregnancy. Methods 39 cases of perinatal pregnant women with ITP who admitted to Peking University People's Hospital from June 2013 to December 2017, were selected as the experimental group(ITP group). 40 cases of gestational thrombocy to penia(GT) and 40 cases of normal pregnant women who were the same in age and gestational week, were selected as comparative and normal control group correspondingly. The expressions of specific gene Foxp3 of CD4+CD25+Treg cells and TLR4 of DCs in the peripheral blood were measured and compared by real-time PCR. Results(1)Compared with normal control group, the expressions of Foxp3 in ITP group and GT group were both reduced, with statistical differences(P < 0.05). The reduction of Foxp3 were consistent with the reduce of CD4+CD25+Treg cells and PLT counts.(2)The expressions of TLR4 in ITP group and GT group were both reduced with statistical differences(P < 0.05). There is no statistical difference between ITP and GT. The reduction degree of TLR4 were consistent with the reduce of DCs and PLT counts. Conclusions The expression of Foxp3 and TLR4 were both reduced in gestational ITP patients, and the reduce tendency were consistent with the reduce of CD4+CD25+Treg and DCs correspondingly. The interaction play a role in the pathogenesis of ITP during pregnancy, and both can be used as clinical monitoring indicators in pregnancy patients with ITP.
引文
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[5]陈哲,梁梅英,等.CD4+CD25+调节性T细胞与树突状细胞在妊娠期血小板减少发病机制中的作用[J].中国妇产科临床杂志,2015,16(3):205-208.
[2]Bigley V,Barge D,Collin M:Dendritic cell analysis in primary immunodeficiency.Current opinion in allergy and clinical immunology 2016,16(6):530-540.
[3]Provan D,Stasi R,Newland AC,et al.International consensus report on the investigation and management of primary immune thrombocytopenia[J].Blood,2010,115(2):168-186.
[4]Nishimoto T,Kuwana M.CD4+CD25+Foxp3+regulatory Tcells in the pathophysiology of immune thrombocytopenia[J].Semin Hematol,2013,50:S43-S49.
[5]陈哲,梁梅英,等.CD4+CD25+调节性T细胞与树突状细胞在妊娠期血小板减少发病机制中的作用[J].中国妇产科临床杂志,2015,16(3):205-208.