原发免疫性血小板减少症患者外周血CD4+T淋巴细胞表面PD-1表达水平分析

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摘要目的检测原发免疫性血小板减少症（ITP）患者外周血CD4+T淋巴细胞表面程序性死亡因子-1（PD-1）的表达水平，探讨PD-1在ITP发病过程中的作用。方法选取河北北方学院附属第一医院（以下简称“我院”）血液科2015年12月—2017年12月收治的100例ITP患者作为研究组，给予0.15 mg/（kg·d）的地塞米松静脉输注，1次/d或0.8 mg/（kg·d）的甲泼尼龙静脉输注，1次/d，病情好转后改为1 mg/（kg·d）泼尼松顿服，一共连续治疗4周。选择同期在我院门诊进行体检的50名健康者作为对照组。采用流式细胞术检测外周血CD4+T淋巴细胞表面PD-1表达情况。观察研究组治疗前后血小板计数及CD4+T淋巴细胞表面PD-1阳性表达率的变化，按治疗效果将研究组分成完全反应组、有效组和无效组，比较不同治疗效果组CD4+T淋巴细胞表面PD-1阳性表达率的差异。结果治疗后，研究组血小板计数高于治疗前，但仍低于对照组，差异均有统计学意义（均P ＜ 0.05）。治疗后，研究组CD4+T淋巴细胞表面PD-1阳性表达率低于治疗前，但仍高于对照组，差异均有统计学意义（均P ＜ 0.05）。治疗后，完全反应组和有效组CD4+T淋巴细胞表面PD-1阳性表达率均较治疗前降低，差异均有统计学意义（均P ＜ 0.05），无效组治疗前后CD4+T淋巴细胞表面PD-1阳性表达率比较，差异无统计学意义（P ＞ 0.05）。完全反应组CD4+T淋巴细胞表面PD-1阳性表达率低于有效组和无效组，有效组低于无效组，差异均有统计学意义（均P ＜ 0.05）。结论外周血CD4+T淋巴细胞表面PD-1表达上调可能与ITP患者疾病发展程度及预后有关。

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	陈哲1 张灵1 刘洁1 张斌2 高炳华1

关键词 ：免疫性血小板减少症, 程序性死亡因子-1, T淋巴细胞, 细胞因子

Abstract：Objective To detect the expression level of programmed death factor-1 (PD-1) on the surface of CD4+T lymphocytes in peripheral blood of patients with primary immune thrombocytopenia (ITP), and to investigate the role of PD-1 in the pathogenesis of ITP. Methods A total of 100 ITP patients admitted to the Department of Hematology, the First Affiliated Hospital of Hebei North University (hereinafter referred to as “our Hospital”) from December 2015 to December 2017 were selected as the study group. Dexamethasone intravenous infusion of 0.15 mg/ (kg·d) was administered once per day or methylprednisolone intravenous infusion of 0.8 mg/(kg·d) was administered once per day, and prednisolone administration 1 mg/ (kg·d) were given after improvement, and the treatment lasted for four weeks. A total of 50 healthy subjects who underwent physical examination in our outpatient department during the same period were selected as the control group. The expression of PD-1 on the surface of CD4+T lymphocytes in peripheral blood was detected by flow cytometry. The changes of platelet count and PD-1 positive expression rate on the surface of CD4+T lymphocytes before and after treatment in the study group were observed. According to the treatment effect, the study group was divided into the complete response group, the effective group and the invalid group, and the differences of PD-1 positive expression rate on the surface of CD4+T lymphocytes in different treatment groups were compared. Results After treatment, the platelet count in the study group was higher than that before treatment, but still lower than that in the control group, and the differences were statistically significant (all P ＜ 0.05). After treatment, the positive expression rate of PD-1 on the surface of CD4+T lymphocytes in the study group was lower than that before treatment, but still higher than that in the control group, with statistically significant differences (all P ＜ 0.05). After treatment, the positive expression rates of PD-1 on the surface of CD4+T lymphocytes in both the complete response group and the effective group were lower than that before treatment, and the differences were statistically significant (all P ＜ 0.05). The positive expression rate of PD-1 on the surface of CD4+T lymphocytes before and after treatment in the invalid group showed no statistical significance (P ＞ 0.05). The positive expression rate of PD-1 on the surface of CD4+T lymphocytes in the complete response group was lower than that in the effective group and the invalid group, and that in the effective group was lower than that in the invalid group, with statistically significant differences (all P ＜ 0.05). Conclusion The up-regulated expression rate of PD-1 on the surface of CD4+T lymphocytes in peripheral blood may be related to the degree of disease development and prognosis of ITP patients.

Key words： Immune thrombocytopenia Programmed death factor-1 T lymphocytes Cytokines

基金资助:河北省医学科学研究重点课题计划（20170804）。

引用本文:

陈哲1 张灵1 刘洁1 张斌2 高炳华1. 原发免疫性血小板减少症患者外周血CD4+T淋巴细胞表面PD-1表达水平分析[J]. 中国医药导报, 2021, 18(1): 92-95.
CHEN Zhe1 ZHANG Ling1 LIU Jie1 Zhang Bin2 GAO Binghua1. Analysis on expression level of PD-1 on the surface of CD4+T lymphocytes in peripheral blood of patients with primary immune thrombocytopenia. 中国医药导报, 2021, 18(1): 92-95.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I1/92

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