| Background Primary immune thrombocytopenia(primary immune thrombocytopenia,ITP)is an acquired autoimmune hemorrhagic disease,accounting for about 1/3 of all hemorrhagic diseases,with skin and mucosal hemorrhage as the main clinical manifestations,cerebral hemorrhage and Vital organ bleeding is the main cause of death in ITP patients.Although first-line treatments such as glucocorticoids and gamma globules can provide satisfactory treatment effects for most patients,many patients who have obtained complete responses and effective treatment after treatment still have symptoms of recurrence,and some patients will have symptoms of recurrence.Re-treatment of previously effective drugs is ineffective or resistant.The pathogenesis of ITP is very complicated.In the past,it was generally believed that thrombocytopenia mediated by autoantibodies produced by B cells was the main pathogenesis of ITP.However,with the continuous deepening of research,the value of its immune status in the pathogenesis is gradually being emphasized..As an important part of human immune cells,cellular immunity mediated by T lymphocytes and their secreted cytokines has gradually become a research focus in the field of ITP in recent years.However,there are many controversies at home and abroad in the research on the balance relationship between T cell subsets and cytokines in patients with ITP,and the specific relationship between cytokines and ITP has not been fully elucidated,so further exploration is still needed.Objective To explore the changes in the levels of T lymphocyte-related cytokines(IL-35,TGF-β,IL-17 A,IL-4,and IFN-γ)in patients with ITP and their clinical significance.Methods Twenty-five patients with ITP who were treated in our hospital from September 2019 to November 2020 were selected.20 adults who had a normal physical examination at the physical examination center of this hospital during the same period were used as healthy control groups.The ELISA method was used to detect the ITP group before treatment.Serum IL-35 and TGF-β levels after treatment and healthy control group,Luminex detection technology was used to detect serum L-17 A,IL-4 and IFN-γ levels in ITP group before treatment,after treatment and healthy control group.Compare the level of each cytokine in each group and the correlation between each cytokine and platelet count.Results1.Comparison of cytokine levels between the newly diagnosed ITP group and the healthy control groupIFN-γ in the newly diagnosed ITP group was higher than that in the healthy control group(12.71pg/ml VS 10.48pg/ml,P=0.001),and IL-35,TGF-β and IL-4were all lower than the healthy control group(30.92pg/ml VS 55.55pg/ml,218.05pg/ml VS 1761.08pg/ml,4.99pg/ml VS 10.34pg/ml,P=0.000,0.000,0.000),the difference is statistically significant;IL-17 A and healthy control group There was no significant difference(2.99pg/ml VS 2.99pg/ml,P=0.685).2.Comparison of cytokine levels between the newly diagnosed ITP group and the ITP group after treatmentAfter treatment,serum IFN-γ levels in the ITP group were significantly lower than those in the newly diagnosed ITP group(10.48pg/ml VS 12.71pg/ml,P=0.004),and IL-35,TGF-β,and IL-4 were significantly higher than those in the newly diagnosed ITP group(49.51pg/ml VS 30.92pg/ml,958.26pg/ml VS 218.25pg/ml,7.26pg/ml VS 4.99pg/ml,P=0.000,0.000,0.000),the difference was statistically significant;the two groups of IL-There was no significant difference in 17A(2.99pg/ml VS 2.99pg/ml,P=0.582).3.Comparison of cytokine levels between the ITP group and the healthy control group after treatmentAfter treatment,the TGF-β level of the ITP group was lower than that of the healthy control group(958.26pg/ml VS 1761.08pg/ml,P=0.000),the difference was statistically significant;IFN-γ,IL-35,IL-4,IL-17 A There was no significant difference between the expression of the healthy control group(10.48pg/ml VS10.48pg/ml,49.51pg/ml VS 55.55pg/ml,7.26pg/ml VS 10.34pg/ml,2.99pg/ml VS2.99pg/ml,P=0.526,0.058,0.053,0.952).4.Comparison of cytokine levels between patients in the complete response group and the effective group before treatmentThe cytokine levels of patients in the complete response group and effective group before treatment were statistically analyzed,IL-35(30.58pg/ml VS 30.92pg/ml,P=0.88),TGF-β(228.04pg/ml VS 199.87)pg/ml,P=0.449),IL-17A(3.33pg/ml VS2.99pg/ml,P=0.665),IL-4(7.26pg/ml VS 4.99pg/ml,P=0.566)and IFN-γ(11.58pg/ml VS 12.71pg/ml,P=0.651)There was no significant statistical difference in the expression of the two groups of patients before treatment.5.Comparison of cytokine levels between patients in complete response group and effective groupThe levels of TGF-β,IL-4 and IFN-γ in the complete response group were significantly higher than those in the effective group(1392.54pg/ml VS 927.91pg/ml,11.47pg/ml VS 8.69pg/ml,11.03pg/ml VS 10.48pg/ml,P=0.016,0.011,0.006),the difference was statistically significant;IL-35 and IL-17 A levels were not statistically different(51.53pg/ml VS 31.94pg/ml,2.99pg/ml VS 2.99pg/ml,P=0.413,0.740).6.Comparison of cytokine levels between severe ITP group and non-severe ITP groupThe levels of IL-35 and TGF-β in the severe ITP group were significantly lower than those in the non-severe ITP group(27.49pg/ml VS 31.72pg/ml,160.89pg/ml VS263.14pg/ml,P=0.006,0.004),the difference was statistically significant Significance;there was no statistical difference in the levels of IL-17 A,IL-4 and IFN-γ(2.99pg/ml VS 2.99pg/ml,4.99pg/ml VS 7.26pg/ml,12.71pg/ml VS 12.71pg/ml,P=0.717,0.169,0.818).7.Comparison of cytokine levels between severe ITP group and non-severe ITP group after treatmentStatistical analysis of the levels of cytokines in the severe ITP group and non-severe ITP group after treatment showed that there was no significant difference in the levels of IL-35,TGF-β,IL-17 A,IL-4 and IFN-γ(31.94pg/ml VS 54.06pg/ml,1029.08pg/ml VS 943.25pg/ml,3.66pg/ml VS 2.99pg/ml,10.34pg/ml VS 10.34pg/ml,10.48pg/ml VS 10.48pg/ml,P=0.083,0.575,0.192,0.818,0.869).8.Correlation analysis of each cytokine and platelet count in the newly diagnosed ITP groupIL-35 and TGF-β were positively correlated with platelet count(r=0.439,P=0.028,r=0.451,P=0.024),IL-4,IL-17 A,IFN-γ were not significantly correlated(r=0.074,P=0.724,r=0.123,P=0.56,r=-0.069,P=0.742).9.Correlation analysis of cytokines in the newly diagnosed ITP groupThere is a positive correlation between IL-35 and TGF-β(r=0.399,P=0.048),there is a positive correlation between TGF-β and IL-4(r=0.676,P=0.0OO),and there is no significant correlation between the remaining cytokines correlation.Conclusion ITP patients have abnormal levels of T lymphocyte-related cytokines(IL-35,TGF-β,IL-4 and IFN-γ),and there are differences in cytokine levels in ITP patients at different disease stages.Newly diagnosed ITP patients have Th1 dominant response and Treg functional defects,and abnormal cytokine levels can be restored after treatment. |
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