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 study the relationship between dendritic cells and imbalanced T-lymphocyte differentiation in children with immune thrombocytopenia (ITP) and explore its significance. Methods Lymphocyte subsets and dendritic cells in ITP patients and healthy children were detected respectively by flow cytometry. Results Lower Th cells, Treg cells and the ratio of Th/Ts and higher Ts cells were observed in persistent and chronic ITP patients compared to healthy controls and newly diagnosed ITP patients ( P < 0. 05 ) ; lower Treg cells were observed in newly diagnosed ITP patients compared to healthy controls ( P <0. 05) ; lower absolute counts of pDC and higher ratio of mDC/pDC were observed in chronic ITP compared to healthy controls and newly patients diagnosed ITP ( P < 0. 05). After four-week treatment by glucocorticoid, 39 cases (ti = 60) got complete remission ( CR) ;12 got partial remission ( PR) ; 9 had no remission ( NR). Lower Th cells and higher Ts cells were observed in patients ITP with NR compared to healthy controls and patients with ITP CR ( P < 0. 05 ) ; lower Treg cells and absolute counts of pDC were observed in patients with ITP NR and PR compared to healthy controls ( P < 0. 05 ) ; lower Treg cells and absolute counts of pDC were observed in patients with ITP NR compared to ITP with patients CR (P <0. 05) . Conclusions The proportional disequilibrium of T lymphocytes and DC are associated with the pathogenesis, clinical stages and prognosis of chronic or persistent children ITP.
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