凉血解毒方药对原发免疫性血小板减少症患者外周血CD4＋CD2＋5调节性 T 细胞水平的影响

摘要

目的：观察原发免疫性血小板减少症（ ITP）患者治疗前后外周血CD4＋CD2＋5调节性T细胞水平变化，探讨凉血解毒方药对ITP患者CD4＋CD2＋5调节性T细胞的作用。方法选取56例ITP患者，男12例，女44例；年龄18～62岁，中位年龄29岁。给以凉血解毒方药治疗（地黄止血胶囊2‘．0 g，3次／d，口服，凉血解毒中草药煎剂升板汤，1剂／d）。患者于治疗前、治疗后90 d分别采取外周静脉血，采用流式细胞术检测CD4＋CD2＋5调节性T细胞水平。20例健康体检者为正常对照组。结果治疗后第90天，总有效率为73．2％。56例ITP患者治疗前外周血 CD4＋CD2＋5调节性T细胞表达水平低于正常对照组[（1．01±0．67）％，（2．81±0．52）％]，差异有统计学意义（ P ＜0．05）；重症ITP患者CD4＋CD2＋5调节性 T细胞水平低于非重症患者[（0．71±0．23）％，（1．48±0．64）％]，差异有统计学意义（ P ＜0．01）；患者治疗后90 d CD＋4 CD2＋5调节性T细胞水平高于治疗前[（1．93±0．53）％，（10．1±0．67）％]，与治疗前比较差异有统计学意义（ P ＜0．05）；治疗后有效组CD4＋CD2＋5调节性T细胞水平高于无效组，差异有统计学意义（P ＜0．05）。结论 ITP 患者外周血CD 4＋CD 2＋5调节性 T 细胞水平低于正常对照组（ P ＜0．05）；凉血解毒方药提升CD4＋CD2＋5调节性T 细胞水平可能是治疗ITP的疗效机制。%Objective To observe the change of CD 4+CD2+5 regulatory T cells levels in peripheral blood of patients with primary immune thrombocytopenia ( ITP) before and after treatment with Liangxuejiedu prescription ,and to explore the effect of Liangxuejiedu prescription on the levels of CD 4+CD2+5 regulatory T cells in patients with ITP .Methods Fifty-six patients with ITP,including 12 males and 44 females,mean age 29 (age range :18~62yr),were enrolled in the study.The patients were treated with Liangxuejiedu prescription ( Dihuangzhixue capsule 2.0g once,3 times a day per os plus Shwngban decoction,one dose per day).The levels of CD4+CD2+5regulatory T cells in peripheral blood of patients before and 90 days after treatment were detected by flow cytometry .Besides 20 healthy subjects were served as controls .Results After 90-day treatment,the total effective rate was 73.2%.The levels of CD4+CD2+5 regulatory T cells in peripheral blood of patients with ITP were significantly lower than those in control group [(1.01+0.67)%vs (2.81+0.52)%, P <0.05],moreover,the levels of CD4+CD2+5 regulatory T cells in peripheral blood of patients with severe ITP were significantly lower than those of patients with non-severe ITP [(0.71 +0.23)% vs (1.48 +0.64)%, P <0.01].After 90-day treatment,the levels of CD4+CD2+5 regulatory T cells in peripheral blood of patients with ITP were significantly higher than those before treatment [(1.93 +0.53)%vs (1.01+0.67)%, P <0.05],furthermore,the levels of CD4+CD2+5 regulatory T cells in effectiveness group were significantly higher than those in inefficiency group ( P <0.05).Conclusion The levels of CD4+CD2+5 regulatory T cells in peripheral blood of patients with ITP are significantly lower than those in control group ,and the increase of levels of CD 4+CD2+5 regulatory T cells caused by Liangxuejiedu prescription may be the action mechanism in treatment of ITP .