Objective: To explore the clinical significance of a series of cytokines and peripheral blood immunocyte subsets before and after immunosuppressive therapy in patients with immune thrombocytopenia (ITP).
Methods: The percentages of immunocyte subsets in the peripheral blood of 20 patients with ITP and 20 healthy controls were detected by flow cytometry, including CD3(+), CD4(+), CD8(+), CD4(+)/CD8(+), CD19(+). ELISA was applied to detect the level of serum TNFα, IL-2, IL-6, IL-4, IL-10, IL-11, IL-17, IL-27, transforming growth factor β (TGFβ), thrombopoietin (TPO) of 20 patients with ITP and 20 healthy controls.
Results: The percentage of CD3(+) T lymphocyte, CD4(+) T lymphocyte and the ratio of CD4(+)/CD8(+) T lymphocyte in patients with ITP were lower than those in healthy controls[(62.66 ± 6.58)% vs (69.93 ± 4.81)%, (29.46 ± 5.02)% vs (39.08 ± 3.50)%, 0.97 ± 0.35 vs 1.56 ± 0.26, all P<0.05]. After immunosuppressive therapy, the percentage of CD3(+) T lymphocyte, CD4(+) T lymphocyte and the ratio of CD4(+)/CD8(+) T lymphocyte [(71.49 ± 5.16)%, (39.25 ± 3.21)% and 1.56 ± 0.28] recovered to the same levels in healthy controls. The percentage of CD8(+) T lymphocyte and CD19(+) B lymphocyte in patients with ITP were higher than those in the healthy controls [(30.28 ± 4.63)% vs (25.90 ± 3.06)%, (18.92 ± 4.27)% vs (13.17 ± 3.64)%, all P<0.05]. After treatment of immunosuppressive therapy, the percentage of CD8(+) T lymphocyte and CD19(+) B lymphocyte [(25.16 ± 3.45)% and (11.98 ± 3.68)%] recovered to the similar levels in healthy controls. The serum levels of IL-4, IL-6, IL-11, IL-17 and TPO in patients with ITP were significantly higher than those in healthy controls. While TGFβ level was significantly decreased. There was no significant difference of IL-27 between ITP patients and healthy controls. After the treatment of immunosuppressive therapy, IL-4, IL-6, IL-11, IL-17, TPO and TGFβ were down-regulated while IL-27 was up-regulated. There was no significant difference of IFNγ, TNFα, IL-2 and IL-10 among ITP patients before or after immunosuppressive therapy and healthy controls.
Conclusions: The present study suggests that the aberrant immunocyte subsets and cytokines are involved in the pathogenesis of ITP. Hyper-function of Th2 and Th17, dysfunction of Treg cells, up-regulation of IL-27, IL-11, TPO and other factors may contribute to the pathogenesis of ITP.