目的:探讨CBA技术检测原发性免疫性血小板减少性紫癜(ITP)患者治疗前后外周血Th1/Th2细胞因子水平变化及其临床意义。方法:98例ITP患者分为激素治疗有效组和无效组;选择健康体检正常者40例为对照组,用流式细胞术微珠阵列(CBA)分别检测...目的:探讨CBA技术检测原发性免疫性血小板减少性紫癜(ITP)患者治疗前后外周血Th1/Th2细胞因子水平变化及其临床意义。方法:98例ITP患者分为激素治疗有效组和无效组;选择健康体检正常者40例为对照组,用流式细胞术微珠阵列(CBA)分别检测各组治疗前和治疗后4周、3个月、6个月外周血Th1细胞因子(IFN-γ,TNFα、IL-2)和Th2细胞因子(IL-4、IL-5、IL-10)水平,并分析指标间的变化关系。结果:治疗前,初治ITP组外周血Th1细胞因子明显高于正常对照组,Th2细胞因子明显低于正常对照组,差异均有统计学意义(P<0.05),IL-2/IL-4比值明显高于正常对照组;治疗后,激素治疗有效组Th1细胞水平均较治疗前明显下降,IL-2/IL-4比值也明显下降,与治疗前相比,治疗6个月后IL-2/IL-4比值为(1.05±0.43 vs 2.53±0.72),其差异均有统计学意义(P<0.05);而激素治疗无效组则无明显变化。结论:初治ITP患者外周血Th1/Th2细胞存在平衡偏移现象,ITP是一种Th1优势疾病,治疗前后IL-2/IL-4的比值变化与预后相关,对指导ITP个体化治疗有一定临床意义。展开更多
Background High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy （LS） difficult to master, and few patients need splenectomy for benign disorders. The aim of this ...Background High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy （LS） difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura （ITP） and to determine which clinical variables predict favorable hematological outcome.Methods LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables （including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count） were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.Results One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months （range 9-114 months）, the overall initial response （i.e., at two months after LS） and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients （3.9%） developed pneumonia 3-35 months after LS. Univariate analysis showed a significant difference in mean age between responders （29.1 years） and nonresponders （38.8 years; P ＜0.05）. Patients who responded to steroid therapy had better hematological outcome than those who did not respond （P ＜0.05）. Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count （404x109/展开更多
文摘目的:探讨CBA技术检测原发性免疫性血小板减少性紫癜(ITP)患者治疗前后外周血Th1/Th2细胞因子水平变化及其临床意义。方法:98例ITP患者分为激素治疗有效组和无效组;选择健康体检正常者40例为对照组,用流式细胞术微珠阵列(CBA)分别检测各组治疗前和治疗后4周、3个月、6个月外周血Th1细胞因子(IFN-γ,TNFα、IL-2)和Th2细胞因子(IL-4、IL-5、IL-10)水平,并分析指标间的变化关系。结果:治疗前,初治ITP组外周血Th1细胞因子明显高于正常对照组,Th2细胞因子明显低于正常对照组,差异均有统计学意义(P<0.05),IL-2/IL-4比值明显高于正常对照组;治疗后,激素治疗有效组Th1细胞水平均较治疗前明显下降,IL-2/IL-4比值也明显下降,与治疗前相比,治疗6个月后IL-2/IL-4比值为(1.05±0.43 vs 2.53±0.72),其差异均有统计学意义(P<0.05);而激素治疗无效组则无明显变化。结论:初治ITP患者外周血Th1/Th2细胞存在平衡偏移现象,ITP是一种Th1优势疾病,治疗前后IL-2/IL-4的比值变化与预后相关,对指导ITP个体化治疗有一定临床意义。
文摘Background High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy （LS） difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura （ITP） and to determine which clinical variables predict favorable hematological outcome.Methods LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables （including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count） were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.Results One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months （range 9-114 months）, the overall initial response （i.e., at two months after LS） and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients （3.9%） developed pneumonia 3-35 months after LS. Univariate analysis showed a significant difference in mean age between responders （29.1 years） and nonresponders （38.8 years; P ＜0.05）. Patients who responded to steroid therapy had better hematological outcome than those who did not respond （P ＜0.05）. Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count （404x109/
