The effect of single course high dose dexamethasone on CD28/CTLA-4 balance in the treatment of patients with newly diagnosed primary immune thrombocytopenia.
The effect of single course high dose dexamethasone on CD28/CTLA-4 balance in the treatment of patients with newly diagnosed primary immune thrombocytopenia.
复制标题
单疗程大剂量地塞米松治疗初诊原发性免疫性血小板减少症患者对CD28/CTLA-4平衡的影响
DOI：
10.1080/21645515.2015.1059975
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发表时间：
2016
影响因子：
4.8
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Guo X;Yasen H;Zhao F;Wang L;Sun M;Pang N;Wang X;Zhang Y;Ding J;Ma X
目的探讨单疗程大剂量地塞米松（HD-DXM）对初治原发性免疫性血小板减少症（ITP）患者CD 28和CTLA-4表达的影响。28例ITP患者（18例女性和10例男性，年龄范围18-65岁，中位年龄38.5岁）入组本研究，26例健康志愿者（19例女性和7例男性，年龄范围16-66岁，中位年龄37岁）作为对照组。HD-DXM（40 mg/d）连续治疗4 d。通过流式细胞术每月一次评估CD 28和CTLA-4表达，持续6个月。采用酶联免疫吸附法测定血浆细胞因子IFN-γ和IL-10水平。治疗后一个月，在23例（82%）患者中观察到血小板反应。按时间顺序，接下来5个月的应答率分别为71%、57%、53%、46%和39%。我们观察到第一个月后CD 28表达显著降低（34.7 ± 4.8% vs.治疗前44.5 ± 4.4%），之后CD 28水平逐渐升高。相比之下，CTLA-4表达在第一个月后增加（3.2 ± 0.5%对治疗前的0.8 ± 0.4），之后CTLA-4水平逐渐降低。在IFN-γ和IL-10水平中观察到类似的动态变化。CD 28、CTLA-4的动态变化与IFN-γ、IL-10的动态变化及HD-DXM治疗ITP的疗效一致。我们的研究结果表明，CD 28/CTLA-4平衡紊乱可能有助于ITP的免疫发病机制。
To evaluate the effect of a single course of high dose dexamethasone (HD-DXM) on CD28 and CTLA-4 expression in patients with newly-diagnosed primary immune thrombocytopenia (ITP). Twenty-8 ITP patients (18 females and 10 males, age range 18–65 years, median age 38.5 years) enrolled in this study and 26 healthy volunteers (19 women and 7 men, age range 16–66 years, median age 37 years) served as a control group. The patients were treated with HD-DXM (40 mg/day) for 4 consecutive days. CD28 and CTLA-4 expression was assessed by flow cytometry once-monthly for 6 months. Plasma levels of the cytokines IFN-γ and IL-10 were determined by enzyme-linked immunosorbent assay. One month after treatment, a platelet response was observed in 23 (82%) of the patients. The response rates over the next 5 months were 71%, 57%, 53%, 46%, and 39%, chronologically. We observed a significant decrease in CD28 expression after the first month (34.7 ± 4.8% vs. 44.5 ± 4.4% before treatment), after which the CD28 levels gradually increased. In contrast, CTLA-4 expression increased after the first month (3.2 ± 0.5% vs. 0.8 ± 0.4 before treatment), after which the CTLA-4 levels gradually decreased. Similar dynamic changes were seen in the levels of IFN-γ and IL-10. The dynamic changes of CD28 and CTLA-4 were consistent with those of IFN-γ and IL-10 and with the effectiveness of HD-DXM in the treatment of ITP. Our results suggest that a disturbed CD28/CTLA-4 balance may contribute to the immunopathogenesis of ITP.