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目的探讨树突状细胞(DCs)在儿童慢性免疫性血小板减少症(cITP)中的变化以及糖皮质激素对cITP患儿DCs的作用。方法流式细胞术分别检测15例cITP患儿应用糖皮质激素治疗前后和20例对照者外周血DCs亚群的变化;体外培养并收集cITP患儿外周血单核细胞来源的DCs,采用流式细胞术检测其免疫表型。结果与对照组比较,cITP患儿治疗前髓样DC(mDC)绝对数无明显改变,浆细胞样DC(pDC)绝对数降低,mDC/pDC比值增高(P<0.05);cITP治疗后,pDC绝对数较治疗前增高,而mDC绝对数及mDC/pDC比值较治疗前降低(P<0.05);cITP患儿治疗前外周血DCs的HLA-DR、CD80、CD83和CD86阳性表达率均明显高于对照组(均P<0.01);治疗后cITP患儿DCs的HLA-DR、CD80、CD83和CD86表达率较治疗前均明显下降(P<0.01),与对照组比较差异无统计学意义(P>0.05)。结论 DCs亚群比例失衡及功能失调与儿童cITP的发病有关;糖皮质激素能增强cITP患儿DCs的免疫抑制效应,可能是糖皮质激素有效治疗儿童cITP的机制。
Objective To investigate the changes of dendritic cells (DCs) in children with chronic immunological thrombocytopenia (cITP) and the effect of glucocorticoid on DCs in cITP children. Methods Flow cytometry was used to detect the subsets of peripheral blood DCs in 15 cITP children before and after corticosteroid treatment and in 20 controls. DCs derived from peripheral blood mononuclear cells of cITP children were cultured and collected in vitro. Cytometry detected its immunophenotype. Results Compared with the control group, the absolute number of myeloid DC (mDC) in cITP children had no significant change, the absolute number of plasmacytoid DC (pDC) and the ratio of mDC / pDC increased (P <0.05); after cITP treatment, The absolute numbers of mDC and mDC / pDC were lower than those before treatment (P <0.05). The positive rates of HLA-DR, CD80, CD83 and CD86 in peripheral blood DCs before cITP treatment were significantly higher (P <0.01). The expression of HLA-DR, CD80, CD83 and CD86 in DCs of cITP children after treatment were significantly lower than those before treatment (P <0.01), but there was no significant difference between the two groups P> 0.05). Conclusions The imbalance and dysfunction of DC subsets are related to the onset of cITP in children. Glucocorticoid can increase the immunosuppressive effect of DCs in cITP children, which may be the mechanism of corticosteroids in the treatment of cITP in children.