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目的 探讨白细胞介素(IL)18及IL-18结合蛋白(IL-18BP)在原发免疫性血小板减少症(ITP)脾脏中的表达及其临床意义.方法 收集山东大学齐鲁医院和山东大学附属省立医院2007年12月至2008年12月ITP患者行外科手术治疗的脾切除标本(n=12)及另取的因创伤性脾破裂而行手术切除的患者的正常脾标本(n=10),应用免疫组化和免疫荧光技术检测2组脾脏组织中IL-18、IL-18BP的表达;反转录-聚合酶链反应(RT-PCR)方法检测脾脏IL-18、IL-18BP、干扰素(IFN)γ,IL-4等细胞因子的mRNA表达.结果 免疫组化及免疫荧光结果显示IL-18在ITP组患者中阳性率为100%(12/12),高于对照组表达率(90.0%,9/10);IL-18BP在ITP组患者阳性率为83.3%(10/12),高于对照组脾脏中阳性率(60.0%,6/10).ITP组患者脾脏中IL-18 mRNA表达为对照组的6.0倍(P＜0.05),虽IL-18BP的mRNA含量亦有升高,但不能代偿明显升高的IL-18的含量.ITP患者IFN-γmRNA表达是对照组10.2倍,而IL-4 mRNA表达较对照组低,为对照组的41.7%,差异均有统计学意义(均P＜0.05).结论 IL-18/IL-18BP在ITP的免疫紊乱和发生发展中起着一定的作用,提示通过增加IL-18BP含量拮抗IL-18的产生及活性可能是ITP治疗的一个新的策略和方向.

Objective To investigate the role of IL-18 and IL-18BP balance in the spleens of patients with primary immune thrombocytopenia (ITP). Methods A total of 12 active ITP patients and 10 normal controls were recruited. Their expressions of 1L-18 and IL-18BP were measured by immunohistochemistry (IHC) and immunofluorescence. The mRNA expressions of IL-18, IL-1 8 BP, IFN-γ and IL-4 were studied by reverse transcription-polymerase chain reaction (RT-PCR) in all subjects. Results The positive rate of IL-18 was higher in the ITP patients than that of the normal control group ( 100% vs 90. 0% ). And the positive rate of IL-18BP was higher in the ITP patients than that of the normal control spleen (83. 3% vs 60. 0% ). The relative amount of mRNA gene expression of IL-18 was increased 6. 0-fold in active patients compared to controls(P ＜ 0. 05). But the elevated mRNA content of IL-18BP failed to compensate for the sharply elevated content of IL-18. As compared with the normal control group, the expression level of IFN-γ mRNA expression was significantly increased 10. 2-fold in ITP patients ( P ＜0. 05). The decrease observed in IL-4 was 41.7% in active patients compared to controls ( P ＜ 0. 05).Conclusion The IL-18/IL-18BP imbalance plays an important role in pathogenesis of ITP and its correction may become a potential therapeutic target for ITP.