Clinical Significance Of Peripheral Blood NK Cell Ratio In Patients With Primary Immune Thrombocytopenia

Objective:To investigate the clinical significance of the proportion of natural killer(NK)cells in peripheral blood lymphocyte subsets in patients with primary immune thrombocytopenia(ITP)at the initial diagnosis.Methods:A total of 149 ITP patients were admitted to the Second Hospital of Shanxi Medical University from June 2012 to May 2018.Among them,there were 61 males and 88females.The ratio of males to females was 0.7:1,and the median age of onset was 44(13-87).According to the proportion of NK cells,the patients were divided into three groups:NK cell decreased group(n=89),normal group(n=56)and elevated group(n=4).Age,sex,platelet count,lymphocyte count,helper T cell(Th cell),suppressor T cell(Ts cell),NK cell,CD19~+cell ratio and bleeding score were recorded before treatment in each group.The clinical characteristics of the three groups were compared.High-dose dexamethasone,intravenous gamma globulin,intravenous gamma globulin combined with dexamethasone,recombinant human thrombopoietin combined with dexamethasone,recombinant human thrombopoietin combined with intravenous gamma globulin combined with dexamethasone were administered respectively.The treatment time of each scheme was different,and the follow-up period was 15(0.5-68)months.To summarize the onset time,complete response time and recurrence time of treatment in each group,and compare the curative effect and prognosis of different groups.Results:1.NK cell reduction group accounted for 59.7%,with a median onset age of 41(13to87)years and an average age of(43.01±20.00)years.The normal NK cell group accounted for 37.6%,the median age of onset was 46.5(17-84)years,with an average age of(44.32±18.21)years.The elevated NK cell group accounted for 2.7%,and the median age of onset was 61(61-73)years,with an average age of(64.03±5.20)years.There was no significant difference in platelet count,lymphocyte count,Th cell,Ts cell and CD19~+cell percentage among the three groups before treatment(P>0.05).According to the statistical analysis,different treatments were individualized,and the median follow-up time was 15(0.5-68)months.There was no significant difference in clinical efficacy between the groups(P>0.05).2.There was a positive correlation between the age of ITP patients and the proportion of Th cells and bleeding score before treatment(r=0.175,0.206).The proportion of Ts cells in ITP patients was negatively correlated with the proportion of Th cells,NK cells and CD19~+cells(r=-0.501,-0.247,-0.355).Conclusion:1.The decrease of NK cell proportion may be related to the pathogenesis of ITP.2.Elderly patients with ITP have a higher risk of bleeding,so we should attach great importance to the bleeding of elderly ITP.3.Detecting the ratio of NK cells in peripheral blood of ITP patients and observing the changes of NK cells may be of some significance for the prognosis evaluation of ITP.