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目的探讨树突状细胞和T淋巴细胞分化失衡与儿童免疫性血小板减少症(ITP)的关系及临床意义。方法用流式细胞术分别检测ITP患儿和对照者外周血Th细胞、Ts细胞、Treg细胞及树突状细胞变化。结果在持续性和慢性ITP组中Th细胞、Treg细胞和Th/Ts细胞比值降低,而Ts细胞升高,与对照组相比差异有显著性(P<0.05),与新诊断ITP组相比差异亦有显著性(P<0.05);Treg细胞在新诊断ITP组降低,与对照组比较差异有显著性(P<0.05);在慢性ITP组中浆细胞样树突状细胞(pDC)绝对值降低,髓样树突状细胞(mDC)/pDC比值增高,与对照组和新诊断ITP组比较差异有显著性(P<0.05)。60例ITP患儿经过糖皮质激素治疗后有39例完全缓解,12例部分缓解,9例无效。在无效组中Th细胞降低,而Tc细胞增高,与对照组和完全缓解组比较差异有显著性(P<0.05);Treg细胞和pDC绝对值在无效组和部分缓解组中降低,与对照组比较差异有显著性(P<0.05),无效组与完全缓解组比较差异亦有显著性(P<0.05)。结论 T淋巴细胞亚群和DC亚群比例失衡与儿童持续性和慢性ITP的发病及儿童ITP的临床分期和预后有关。
Objective To investigate the relationship between unbalanced differentiation of dendritic cells and T lymphocytes and childhood immune thrombocytopenia (ITP) and its clinical significance. Methods The changes of Th cells, Ts cells, Treg cells and dendritic cells in ITP children and controls were detected by flow cytometry. Results The ratio of Th cells, Treg cells and Th / Ts cells was decreased and Ts cells were elevated in both chronic persistent and chronic ITP groups compared with the control group (P <0.05). Compared with the newly diagnosed ITP group (P <0.05). The number of Treg cells in the newly diagnosed ITP group was significantly lower than that in the control group (P <0.05). In the chronic ITP group, the plasmacytoid dendritic cells (pDC) (MDC) / pDC ratio increased compared with the control group and the newly diagnosed ITP group (P <0.05). Of the 60 ITP children who underwent glucocorticoid therapy, 39 were completely relieved, 12 were partially relieved, and 9 were ineffective. Th cells decreased and Tc cells increased in the ineffective group compared with the control group and the complete remission group (P <0.05); the absolute value of Treg cells and pDC decreased in the ineffective group and partial remission group, compared with the control group The difference was significant (P <0.05), and the difference between the invalid group and the complete remission group was also significant (P <0.05). Conclusion The unbalanced proportions of T lymphocyte subsets and DC subsets are related to the incidence of persistent and chronic childhood ITP and the clinical stage and prognosis of childhood ITP.