【作者】 赖海生；

【导师】 黄瑞滨；

【作者基本信息】 南昌大学 ， 内科学， 2011， 硕士

【摘要】 目的探讨免疫性血小板减少性紫癜(ITP)患者血清中白介素-21(IL-21)与B细胞激活因子(BAFF)表达水平及临床意义方法46例ITP患者中(ITP组),男性14例,女性32例,年龄16-74岁,中位年龄36岁。进一步按照ITP患者发病时间及出血严重程度进行分组,其中新诊断ITP组17例、持续性ITP组5例、慢性ITP组20例、重症组3例、难治性ITP组1例。另选择同时期住院的10例其他原因血小板减少患者(NITP组),其中男性4例,女性6例,年龄16-57岁,中位年龄40岁。以性别和年龄相符合的20例健康体检者(健康对照组),男性10例,女性10例,年龄16～70岁,中位年龄39岁。采用酶联免疫吸附法(ELISA)检测ITP患者治疗前及治疗后、NITP患者以及健康体检者血清中IL-21、BAFF表达水平。结果1.ITP组治疗前血清IL-21表达水平明显高于健康对照组(551.79±48.15pg/ml vs 480.2±28.28pg/ml,p<0.01)；但与NITP组无明显统计学差异(551.79±48.15pg/ml vs 567.27±92.64 pg/ml, p=0.619);2.ITP组治疗前血清BAFF表达水平明显高于健康对照组(721.03±117.7pg/ml vs 512.5±86.91pg/ml, p<0.01);但与NITP患者组无明显统计学差异(721.03±117.7pg/ml vs 782.0±138.08pg/ml, p=0.128);3.ITP组治疗后血清中IL-21和BAFF表达水平明显下降(分别为468.05±30.11pg/ml,548.57±88.33pg/ml),并与健康对照组比较无统计学意义；4.按ITP患者疾病分期中(新诊断ITP、持续性ITP、慢性ITP、重症ITP、难治性ITP),各亚组血清IL-21、BAFF表达水平与疾病严重程度分期呈正相关(r分别为0.833、0.785,P均<0.01)；5.ITP组血清IL-21表达水平与出血分级、血小板计数之间无相关关系(r=—0.246,p=0.099；r=—0.028,p=0.856)；ITP组血清BAFF水平与出血分级、血小板计数之间亦无相关关系(r=0.03,p=0.845；r=0.028,p=0.856)；6.1TP组血清IL-21与BAFF表达水平呈正相关关系(r=0.659,p<0.01)；7.ITP患者在大剂量地塞米松治疗组与标准剂量糖皮质激素治疗组治疗前后血清IL-21、BAFF表达水平无明显统计学意义。结论ITP患者血清中IL-21和BAFF表达明显升高,且二者与疾病严重程度呈正相关,给予糖皮质激素后血清IL-21和BAFF表达水平明显下降,提示IL-21和BAFF可能参与了ITP疾病进程。更多还原

【Abstract】 Objective:To investigate the expression of IL-21、BAFF in immune thrombocyto-penic purpura (ITP) and its significanceMethods:46 cases of ITP patients(ITP group) were recruited:male 14, female 32, aged 16 to 74 years, median age was 36 years.The ITP patients were divided into different groups according to time of onset and severity of bleeding, of which 17 patients newly diagnosed ITP, persistent ITP group of 5 patients,20 cases of chronic ITP,3 patients of severe ITP,1 case of refractory ITP group.10 patients with non-ITP thrombocytopenic patients (NITP group) in the same period hospitalized were aslo recruited:4 males and 6 females, aged 16 to 57 years, the median age 40 years.20 healthy subjects (control group) were recruited:10 males and 10 females, aged 16 to 70 years, the median age 39 years. The levels of IL-21 and BAFF in serum of ITP patients before and after treatment, NITP patients and healthy subjects were measured by enzyme-linked immunosorbent assay (ELISA).Resulrs:1.Compared with the normal controls, the level of serum IL-21 in the patients of untreated immune thrombocytopenic purpura were significantly higher (551.79±48.15pg/ml vs 480.2±28.28pg/ml, p<0.01), but no significant difference with NITP group (551.79±48.15pg/ml vs 567.27±92.64 pg/ml, p＝0.619);2. Compared with the normal controls, the levels of serum BAFF in the patients of untreated immune thrombocytopenic purpura were significantly higher (721.03±117.7pg/ml vs 512.5±86.91pg/ml, p<0.01); but no significant difference with NITP group (721.03±117.7pg/ml vs 782.0±138.08pg/ml, p=0.128);3. The levels of serum IL-21 and BAFF in the patients with ITP after treatment,were significantly decreased (468.05±30.11pg/ml,548.57±88.33pg/ml respectively), and no significant difference with the control group;4.In the disease respectively stage with ITP (the newly diagnosed ITP, persistent ITP, chronic ITP, severe ITP, refractory ITP), the levels of serum IL-21, BAFF and disease severity was positively correlated (r=0.833,0.785;P<0.01).5.There were no significant correlation between the levels of serum IL-21 in patients and the bleeding grade level or the peripheral blood platelet count (r=-0.0246,-0.028respectively); Aslo, there were no significant correlation between the levels of serum BAFF in patients and the bleeding grade level or the peripheral blood platelet count (r= 0.03,0.028 respectively);6.The levels of serum IL-21 with ITP patients showed a positive correlation and regression with the levels of serum BAFF in all subjects(r=0659, p<0.01);7. The levels of serum IL-21 or BAFF with the ITP patients in the high-dose dexamethasone treatment group and the standard dose glucocorticoid treatment group,were not statistically significant.Conclusion:The levels of serum IL-21 and BAFF were significantly increased in ITP patients.Also,the relationship of IL-21 and BAFF was positively correlated. Furthermore, the levels of serum IL-21 and BAFF were significantly decreased after glucocorticoid treatment.The result suggests that IL-21 and BAFF may play a important role in ITP.更多还原