摘要目的 探讨重组人白细胞介素(recombinant human interleukin,rhIL)11治疗特发性血小板减少症(idiopathic thrombocytopenic purpura,ITP)对 Thl、Th2水平及其转录因子 T-bet mRNA、GATA-3 mRNA表达水平的影响.方法 收集2015年5月至2016年12月在大同市第二人民医院血液科住院治疗的成人ITP患者,共56例,男21例,女35例;年龄29~73岁;我院同期体检健康人10名为对照组,男4名,女6名;年龄20~52岁.使用rhIL-11治疗ITP患者,流式细胞仪检测治疗前后Th1、Th2细胞比例及Th1/Th2比值;实时荧光定量逆转录-多聚酶链反应(RT-PCR)分析转录因子T-bet和GATA-3 mRNA表达.结果 rhIL-11治疗ITP有效率为76.8%(43/56).对于有效的患者,治疗后PLT中位数明显升高为[25.0(15.0,36.0)]×109/L与[68.0(49.0,108.0)]×109/L(Z=-5.712,P<0.001);Th1细胞较治疗前下降[14.8%(12.6%,17.6%)与10.6%(9.8%,12.6%),Z=-4.825,P<0.001];Th2细胞水平较治疗前升高[0.4%(0.3%,0.5%)与1.2%(0.9%,1.4%),Z=-5.720,P<0.001];Th1/Th2治疗后比治疗前明显降低[40(30,49)与10.6(7.8,12.0),Z=-5.711,P<0.001];T-bet mRNA表达水平较治疗前下降[0.36 (0.18,0.51)与0.09(0.05,0.13),Z=-2.668,P=0.008];GATA-3 mRNA表达水平较治疗前升高[0.04 (0.03,0.05)与0.12(0.09,0.15),Z=-2.366,P=0.018].对于无效的患者,治疗前PLT中位数为11.0 (8.0,15.5)×109/L,治疗后PLT中位数为15.0(10.0,19.5)×109/L(Z=-3.027,P=0.002);ITP患者治疗前后Th1、Th2细胞水平、Th1/Th2比率以及T-bet和GATA-3 mRNA的表达水平差异无统计学意义(P均>0.05).结论 rhIL-11可有效纠正 ITP 患者体内 Th1、Th2细胞失衡,及其相应的调控因子 T-bet、GATA-3的失衡;但对少部分患者无明显的治疗作用.

abstractsObjective To investigate the effect of recombinant human interleukin 11(rhlL-11)in the treatment of idiopathic thrombocytopenic purpura(ITP)on the levels of Th1,Th2 and the expression of their transcription factors T-bet mRNA,GATA-3 mRNA.Methods Fifty-six cases adult ITP patients hospitalized in the department of hematology of the Second People's Hospital of Datong from May 2015 to December 2016 were collected,including 21 males and 35 females,aged 29~73 years; 10 healthy people in the same period were enrolled as control group,4 males and 6 females,aged 20~52 years.Th1 and Th2 cell ratio and Th1/Th2 ratio of ITP patients were detected by flow cytometry before and after treatment.The expression levels of transcription factor T-bet and GATA-3 were measured using real-time fluorescence quantitative reverse transcription polymerase chain reaction(RT-PCR)before and after treatment.Results The effective rate of rhlL-11 in ITP treatment was 76.8%(43/56).For the effective patients,the median PLT after treatment increased(25.0(15. 0,36.0)×109/L vs.68.0(49.0,108.0)×109/L,Z=-5.712,P<0.001); Th1 cells decreased,compared with that before the treatment(14.8 %(12.6%,17.6%)vs.10.6 %(9.8%,12.6%),Z=-4.825,P<0.001);Th2 cell increased,compared with that before the treatment(0.4%(0.3%,0.5%)vs.1.2%(0.9%,1.4%), Z=-5.720,P<0.001); Th1/Th2 decreased,compared with that before the treatment(40(30,49)vs.10.6(7.8,12.0),Z=-5.711,P<0.001];the expression level of T-bet mRNA decreased(0.36(0.18,0.51)vs 0.09(0.05,0.13),Z=-2.668,P=0.008);the expression level of GATA-3 mRNA increased,compared with that before treatment(0.04(0.03,0.05)vs.0.12(0.09,0.15),Z=-2.366,P=0.018).For ineffective patients,the median PLT before treatment was(11.0(8.0,15.5)×109/L),and the median PLT after treatment was(15.0(10.0,19.5)×109/L)(Z=-3.027,P=0.002); there was no significant difference in Th1,Th2, ratio of Th1/Th2 and T-bet and GATA-3 mRNA expression level before and after treatment in patients with ITP (P>0.05).Conclusion rhIL-11 can effectively correct the imbalance in Th1 and Th2 cells and the imbalance of T-bet and GATA-3 in ITP patients,but it has no obvious therapeutic effect on a small number of patients