The Effect Of Different Doses Intravenous Immunoglobulin On Children's Immune Thrombocytopenia And Its Effect On Regulatory B Cells

Immune thrombocytopenia(ITP)is a common bleeding disease in the blood system.It's often self-limited in children,and spontaneous bleeding of skin and mucous membrane is common.It's a classic pathogenesis of immune thrombocytopenia that B cells mediate platelet destruction and reduce generation by producing autoantibodies.In recent years,it has been found that abnormal cellular immunity,cytotoxic lysis pathway,Hp infection and abormal gene expression play an important role in ITP.Recently,it has been pointed out that the number and function of regulatory B cells(Bregs)are missing in the pathogenesis of acute ITP.Gamma globulin is a common drug for the treatment of acute ITP in children,but IVIG is expensive,which limits its clinical application rate.Currently,some scholars have proposed to reduce the dose on the premise of ensuring the curative effect of children,however,it has not been determined whether it could achieve the same curative effect as the standard dose.In this study,we detected the platelet count,IL-10 level and CD19~+ CD24~+ CD38~+ CD45~+Breg ratio before and after treatment with different doses of gamma globulin in children with acute ITP,and explored the role of regulating B cells and cytokines in the pathogenesis of ITP and the short-term therapeutic effect and mechanism of low dose gamma globulin therapy on ITP.Objective: To detect the platelet count,IL-10 level and CD19~+ CD24~+ CD38~+ CD45~+Breg ratio before and after treatment with different doses of gamma globulin in children with acute ITP,and explore the role of regulating B cells and its cytokines in the pathogenesis of ITP and the short-term therapeutic effect and mechanism of low dose gamma globulin therapy on ITP.Methods: From October 2018 to may 2019,50 newly diagnosed children with acute ITP were randomly divided into low-dose group and high-dose group,25 in each group,and 25 in control group.Intravenous immunoglobulin(IVIG)400mg /(kg·d)was given to low-dose group for 2 consecutive days,and IVIG 1.0g /(kg·d)to high-dose group for 2 consecutive days.The peripheral blood platelet,the serum IL-10 level and the ratio of CD19~+CD24~+CD38~+CD45 ~+ Breg Cells in the peripheral blood mononuclear cells(PBMC)were measured before and after IVIg treatment,the serum IL-10 level was measured by bdtmcytometric bearray human Th1 / Th2 / Th17 cytokine Kit(CBA),and he ratio of CD19~+CD24~+CD38~+CD45~+Breg was accounted by flow cytometry.And all those were compared with the control group.Results: there was no significant difference between the effects of the two doses of gamma globulin in the treatment of children with acute ITP(Z= 4.335,P > 0.05).The expression level of IL-10[(6.01 ± 3.67)pg / ml] in children with acute ITP before IVIG treatment was significantly higher than that in the control group [(2.85 ± 2.46)pg / ml](P < 0.05),and the ratio of CD19~+CD24~+CD38~+ CD45~+ Breg [(20.97 ± 11.92)%] was lower than that in the control group [(26.25 ± 7.49)%](P < 0.05).The level of IL-10 in the low and high dose group after treatment [(4.75 ± 2.50)pg / ml,(5.22 ± 3.90)pg / ml] was significantly lower than that before treatment [(5.39 ± 3.15)pg / ml,(6.64 ± 4.09)pg / ml](P < 0.05).The ratio of CD19~+CD24~+CD38~+CD45~+ Breg in the low and high dose groups after treatment [(23.03 ± 13.24)%,(24.58 ± 12.23)%]was significantly higher than that before treatment [(19.36 ± 12.73)%,(22.58 ± 11.07)%](P < 0.05).Whatever before IVIG treatment and after IVIG treatment,there was no significant difference in the expression of IL-10 and the ratio of CD19~+ CD24~+CD38~+CD45~+Breg between the low dose group and the high dose group(P > 0.05).After the treatment with IVIG,the ratio of CD19~+CD24~+CD38~+CD45~+Breg and the expression level of IL-10 of two groups after IVIG treatment was no significant difference with that of the control group(P > 0.05).There was no correlation between the ratio of CD19~+CD24~+CD38~+CD45~+Breg and the level of IL-10 expression,whatever before the IVIG treatment and after the IVIG treatment in two groups(P > 0.05).Conclusion: 1.CD19~+CD24~+CD38~+CD45~+Breg was immunodeficient in children with acute ITP.Immunoglobulin could up regulate the proportion of CD19~+CD24~+ CD38~+CD45~+Breg,and enhance the secretion of IL-10 by CD19~+CD24~+CD38~+CD45~+Breg;2.There was no significant difference in the therapeutic effect of IVIG in children with acute ITP.