疏风凉血补肾法干预下CITP患者PD-1/PD-L变化规律的研究
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摘要
目的：
免疫性血小板减少性紫癜(Immune thrombocytopenic purpura, ITP)是一种自身免疫性出血性疾病,临床表现为外周血小板(blood platelet, PLT)计数下降,皮肤出血点、紫斑,粘膜和(或)内脏出血等症状,中医认为该病可归属于“血证”、“肌衄”、“发斑”等范畴。目前对ITP发病机制的研究尚未完全明晰,根据多方的深入研究,发现作为一种自身免疫性疾病,细胞免疫紊乱是ITP除体液免疫外重要的发病机制之一,而目前这一研究领域逐渐引起众多的关注。作为细胞免疫重要的组成部分,协同刺激分子可调节淋巴细胞的活化程度,即可使淋巴细胞不断保持在激活状态,又可使淋巴细胞避免过度活化,目前研究发现多种免疫性疾病其发生发展与协同刺激分子表达的失衡关系密切。协同刺激分子有正性与负性之分,过度活化的T淋巴细胞、异常分泌的多种细胞因子,往往与正性协同刺激分子过度表达有关,继而造成B淋巴细胞过度增殖活化,促进抗血小板相关抗体分泌,引起血小板过度破坏；而机体在T淋巴细胞的活化增殖与细胞因子的分泌方面常为负性协同刺激分子所抑制。CD4+亚群(Th细胞)根据自身所分泌的细胞因子,分为Th1和Th2两个亚群,Thl主要分泌IL-2、IFN-γ等细胞因子,主要介导细胞免疫；Th2分泌IL-4、IL10等细胞因子,主要介导体液免疫：Th1和Th2分泌的细胞因子既可促进自身增殖,又能抑制对方细胞因子分泌,并且在一定条件下Th1/Th2功能还可向对方转换。Th1/Th2的平衡是机体免疫功能得以正常维持的重要条件,多种免疫性疾病的发生发展与其平衡失调、细胞因子异常分泌密切相关。
本实验研究从临床入手,在疏风凉血补肾法(方)干预下,采用流式细胞术(Flow CytoMeter, FCM)及酶联免疫吸附法(enzyme linked immunosorbent assay, ELISA),通过检测患者外周血PD-1、PD-L1、sPD-1的表达及与免疫密切相关的Thl/Th2细胞因子IL-2、IL-10的水平变化,在分子水平上研究ITP患者PD-1/PD-L负性协同刺激通路的表达关系及对T细胞功能的影响,阐述其机制,探讨慢性免疫性血小板减少性紫癜(Chronic Immune Thrombocytopenic Purpura, CITP)的发病机理。在此基础上,重点观察祛风凉血补肾法(方)干预下,探讨PD-1、PD-L1与sPD-1之间的关系,并进一步探究负性协同刺激通路PD-1/PD-L与ITP的相互关系,以丰富ITP的中医治疗理论,探寻有效治疗免疫性疾病的中医药理论。
方法：
临床研究
予18例健康对照组。将符合CITP诊断标准和纳入标准的18例患者编为CITP组,予祛风凉血补肾法(方)干预治疗,若需激素者继续加激素治疗(强的松治疗,0.5-1mg/(kg.d))。若出现外感症状,加用解表药物。以4周为一疗程,每治疗一疗程后抽取外周血观测,连续观察3个疗程,观察血小板计数变化,外周血协同刺激分子PD-1、PD-L1.sPD-1的表达以及细胞因子IL-2、IL-10的水平变化情况。
结果：
临床研究结果
1. CITP组血小板计数、PD-1表达均明显低于健康组(P<0.01),sPD-1、IL-2、IL-10表达明显高于健康组(P<0.01),CITP组与健康组在PD-L1表达方面未见明显差异(P＞0.05)。
2.CITP组sPD-1、IL-2、IL-10三者间存在正相关(相关系数r趋向于+1,P均<0.01)；
3.CITP组经疏风凉血补肾法(方)治疗后,PLT较治疗前无明显变化,治疗前后比较无统计学意义(P>0.05),与健康组比较,治疗前后均具有显著统计学意义(P<0.01)。
4.CITP组经疏风凉血补肾法(方)治疗,PD-1表达较治疗前增加,两组比较未达到统计学意义(P>0.05),治疗前PD-1表达与健康组达到显著统计学意义(P<0.01)；治疗后PD-1表达与健康组比较未达到统计学意义(P>0.05)；
5.CITP组经疏风凉血补肾法(方)治疗,在PD-L1方面,治疗后与治疗前无明显变化,治疗前后比较无统计学意义(P>0.05),与健康组比较无统计学意义(P>0.05)。
6.CITP组经疏风凉血补肾法(方)治疗,在sPD-1表达方面,治疗后较治疗前明显减少,治疗前后比较有显著统计学意义(P<0.01),与健康组比较均有显著统计学意义(P<0.01)。
7.CITP组经疏风凉血补肾法(方)治疗,在IL-2表达方面,治疗后较治疗前明显减少,治疗前后比较有显著统计学意义(P＜0.01)；治疗前后IL-2表达均高于健康组,与健康组相比较均有显著统计学意义(P＜0.01)。
8. CITP组经疏风凉血补肾法(方)治疗,在IL-10表达方面,治疗后较治疗前明显减少,治疗前后比较有统计学意义(P＜0.05)；治疗前后与健康组比较均有显著统计学意义(P＜0.01)。
结论：
CITP免疫功能存在紊乱现象,负性协同刺激分子通路PD-1/PD-L发生异常,sPD-1过度表达,PD-1低表达,抑制信号减弱,导致失去正常抑制的正性协同刺激分子过度表达,促进T淋巴细胞数量增加和活化程度增强,引起抗自身免疫强烈的反应,导致T细胞亚群Th1/Th2出现平衡紊乱、细胞因子分泌异常,从而使活化的B细胞出现异常增加,促进抗血小板相关抗体分泌,引起血小板过度破坏,导致ITP发生。疏风凉血补肾法(方)可调节协同刺激分子的表达,通过上调负性协同刺激分子PD-1的表达,降低sPD-1表达,降低细胞因子IL-2、IL-10的表达水平,调节Th1/Th2细胞间的平衡,抑制自身免疫过度反应,减少抗血小板相关抗体过度分泌引起的血小板大量破坏。因此治疗CITP,可从促进负性协同刺激通路PD-1/PD-L的正常表达,调节T淋巴细胞亚群Th1/Th2的平衡状态,调控相关细胞因子分泌,调节免疫失衡状态等方面出发,深入研究中西医结合治疗CITP的理论依据,具有重要的临床价值。
Object ive
Immune thrombocytopenic purpura (1TP) is an autoimmune bleeding disorder, clinical manifestations of peripheral platelet (PLT) count drops, skin bleeding, purpura, mucous membranes, and (or) internal bleeding and other symptoms, Chinese medicine believes that the disease can be attributed to the "blood","muscle bleed at the nose","spots" and other areas. ITP pathogenesis is not yet fully clear, according to the multi-depth study, as an autoimmune disease, the cellular immune disorder is important in the pathogenesis of ITP addition to the humoral immune, and this field of research is of growing the concern of many. Costimulatory molecules can adjust the degree of lymphocyte activation as an important part of cell-mediated immunity, can continue to remain in the active lymphocytes, but also make lymphocytes to avoid excessive activation of a variety of autoimmune diseases its development, the current study found and co-stimulatory molecule expression closely related to the Imbalance. Costimulatory molecules with positive and negative stars, excessive act-ivation of T lymphocytes, abnormal secretion of a variety of cytokines, often with positive costimulatory molecules excessive expression, which in turn caused by excessive proliferation and activation of B lymphocytes, to promote anti-platelet related antibody secretion, causing excessive platelet destruction; the body negative costimulatory molecules in the activation of T lymphocytes proliferation and cytokine secretion often inhibited. CD4+subsets (Th) cells based on cytokine secretion itself into both Thl and Th2subsets, Thl, secreted IL-2, IFN-gamma and other cytokines, mainly mediated cellular immunity; Th2secretion of IL-4IL-10and other cytokines, mainly mediated humoral immunity; Thl and Th2cytokine secretion can promote their proliferation, but also inhibit each other cytokine secretion, and under certain conditions Thl/Th2function can also be converted to each other. The Th1/Th2balance immune function to maintain normal conditions, the occurrence and development of a variety of autoimmune diseases and its imbalance, abnormal cytokine secretion is closely related.
This study starting from the clinical intervention in the the breeze cooling blood and kidney Law (square) by flow cytometry (Flow Cytometer, FCM) and enzyme-linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA), by detecting patients with peripheral bloodPD-1, PD-L1, SPD-1expression and closely related to the immune the Th1/Th2cytokine IL-2, IL-10' s levels, studied at the molecular level the ITP patients PD-1/PD-L negative synergistic costimulatory pathway expression and T cell function on its mechanism of chronic immune thrombocytopenic purpura (Chronic Immune Thrombocytopenic Purpura, CITP) pathogenesis. On this basis, the key observation expelling wind cooling blood and kidney (square) intervention to explore the PD1, PD-L1and SPD1relationship between, and further explore the negative co-stimulatory pathway PD-1/PD-L relationship with ITP, ITP rich theory of Chinese medicine treatment, to explore the theory of Chinese medicine effective in treating autoimmune diseases.
Methods
Clinical Study
18patients meet the the CITP diagnostic criteria and inclusion criteria numbered CITP group to dispelling wind Liangxue kidney Act (square) intervention For hormone continued hormone therapy (prednisone,0.5-lmg (kg. d)). Exogenous symptoms, plus relieving drugs.4weeks for a course, each extracted peripheral blood observed after a course of treatment, continuous observation of three courses, to observe the changes in platelet count, peripheral blood costimulatory molecule PD-1, PD-L1, SPD-1expression and cytokine IL-2, IL-10levels.
Results
Clinical Experiment Study results
1. CITP platelet count, PD-1expression was significantly lower than the healthy group (P<0.01), SPD-1, IL-2, IL-10expression was significantly higher than in the healthy group (P<0.01) the CITP groups and health groupno significant difference (P>0.05) in the expression of PD-L1.
2. CITP group SPD-1, IL-2, IL-10three positive correlation (correlation coefficient r tends at+1, P all P<0.01).
3. CITP group, the breeze cooling blood and kidney Act (square) after treatment, no significant change in the PLT compared with pre-treatment, the two groups was not statistically significant (P>0.05), compared with healthy controls, before and after treatment were statistically significant (P<0.01).
4. CITP group treatment by the the Shufeng Liangxue kidney Act (square), PD-1expression is increased compared with before treatment, the two groups did not reach statistical significance (P>0.05), treatment before PD-1expression and health groups reached statistical significance(P<0.01); the treatment PD-1expression compared with healthy controls did not reach statistical significance (P>0.05);
5. CITP group treatment by the the Shufeng Liangxue kidney Act (square), PD-L1, after treatment and before treatment, no significant changes in the two groups was not statistically significant (P>0.05), the two groups compared with healthy controls was not statisticallysignificant (P>0.05).
6. CITP group treatment by the the Shufeng cooling blood and kidney Law (square), SPD-1expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.01); two groups are compared with healthy controlsstatistically significant (P<0.01).
7. CITP group treatment by the the Shufeng Liangxue kidney Act (square), IL-2expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.01); before and after treatment were compared with the healthy group, were significantly statistically significant (P<0.01).
8. CITP group, Shufeng Liangxue kidney Act (square) treatment, IL-10expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.05); before and after treatment compared with healthy controls have significantlystatistically significant (P<0.01).
Conclusion
The CITP immune function disorder phenomenon, negative costimulatory the molecular pathways PD-1/PD-L abnormal, SPD-1over-expression of PD-1low expression, inhibition of signal weakened, resulting in loss of normal inhibition of positive costimulatory molecules overexpression, and promote the increase in the number and enhance the degree of activation of T lymphocytes, causing a strong reaction to anti-autoimmune, leading to T cell subsets the Thl/Th2balance disorders, abnormal cytokine secretion, so that the abnormal increase in activated B cells, promote anti-platelet-associated antibody secretion, causing excessive destruction of platelets, resulting in ITP occurs The breeze cooling blood and kidney (square) regulate the expression of costimulatory molecules, negative costimulatory molecule PD-1expression by up-regulating the expression of SPD-1, reduce the cytokines1L-2,1L-10the expression level of adjustment the balance between Thl/Th2cells suppress autoimmune overreaction, to reduce the antiplatelet antibody excessive secretion induced platelet lot of damage. Therefore, treatment CITP, from to promote negative costimulatory pathway PD-1/PD-L normal expression, regulation of T lymphocyte subsets Thl/Th2balance, regulation cytokine secretion, regulate immune imbalance departure, depth study of the theoretical basis for Integrat ive Medicine treatment of CITP has important cli nical value.
免疫性血小板减少性紫癜(Immune thrombocytopenic purpura, ITP)是一种自身免疫性出血性疾病,临床表现为外周血小板(blood platelet, PLT)计数下降,皮肤出血点、紫斑,粘膜和(或)内脏出血等症状,中医认为该病可归属于“血证”、“肌衄”、“发斑”等范畴。目前对ITP发病机制的研究尚未完全明晰,根据多方的深入研究,发现作为一种自身免疫性疾病,细胞免疫紊乱是ITP除体液免疫外重要的发病机制之一,而目前这一研究领域逐渐引起众多的关注。作为细胞免疫重要的组成部分,协同刺激分子可调节淋巴细胞的活化程度,即可使淋巴细胞不断保持在激活状态,又可使淋巴细胞避免过度活化,目前研究发现多种免疫性疾病其发生发展与协同刺激分子表达的失衡关系密切。协同刺激分子有正性与负性之分,过度活化的T淋巴细胞、异常分泌的多种细胞因子,往往与正性协同刺激分子过度表达有关,继而造成B淋巴细胞过度增殖活化,促进抗血小板相关抗体分泌,引起血小板过度破坏；而机体在T淋巴细胞的活化增殖与细胞因子的分泌方面常为负性协同刺激分子所抑制。CD4+亚群(Th细胞)根据自身所分泌的细胞因子,分为Th1和Th2两个亚群,Thl主要分泌IL-2、IFN-γ等细胞因子,主要介导细胞免疫；Th2分泌IL-4、IL10等细胞因子,主要介导体液免疫：Th1和Th2分泌的细胞因子既可促进自身增殖,又能抑制对方细胞因子分泌,并且在一定条件下Th1/Th2功能还可向对方转换。Th1/Th2的平衡是机体免疫功能得以正常维持的重要条件,多种免疫性疾病的发生发展与其平衡失调、细胞因子异常分泌密切相关。
本实验研究从临床入手,在疏风凉血补肾法(方)干预下,采用流式细胞术(Flow CytoMeter, FCM)及酶联免疫吸附法(enzyme linked immunosorbent assay, ELISA),通过检测患者外周血PD-1、PD-L1、sPD-1的表达及与免疫密切相关的Thl/Th2细胞因子IL-2、IL-10的水平变化,在分子水平上研究ITP患者PD-1/PD-L负性协同刺激通路的表达关系及对T细胞功能的影响,阐述其机制,探讨慢性免疫性血小板减少性紫癜(Chronic Immune Thrombocytopenic Purpura, CITP)的发病机理。在此基础上,重点观察祛风凉血补肾法(方)干预下,探讨PD-1、PD-L1与sPD-1之间的关系,并进一步探究负性协同刺激通路PD-1/PD-L与ITP的相互关系,以丰富ITP的中医治疗理论,探寻有效治疗免疫性疾病的中医药理论。
方法：
临床研究
予18例健康对照组。将符合CITP诊断标准和纳入标准的18例患者编为CITP组,予祛风凉血补肾法(方)干预治疗,若需激素者继续加激素治疗(强的松治疗,0.5-1mg/(kg.d))。若出现外感症状,加用解表药物。以4周为一疗程,每治疗一疗程后抽取外周血观测,连续观察3个疗程,观察血小板计数变化,外周血协同刺激分子PD-1、PD-L1.sPD-1的表达以及细胞因子IL-2、IL-10的水平变化情况。
结果：
临床研究结果
1. CITP组血小板计数、PD-1表达均明显低于健康组(P<0.01),sPD-1、IL-2、IL-10表达明显高于健康组(P<0.01),CITP组与健康组在PD-L1表达方面未见明显差异(P＞0.05)。
2.CITP组sPD-1、IL-2、IL-10三者间存在正相关(相关系数r趋向于+1,P均<0.01)；
3.CITP组经疏风凉血补肾法(方)治疗后,PLT较治疗前无明显变化,治疗前后比较无统计学意义(P>0.05),与健康组比较,治疗前后均具有显著统计学意义(P<0.01)。
4.CITP组经疏风凉血补肾法(方)治疗,PD-1表达较治疗前增加,两组比较未达到统计学意义(P>0.05),治疗前PD-1表达与健康组达到显著统计学意义(P<0.01)；治疗后PD-1表达与健康组比较未达到统计学意义(P>0.05)；
5.CITP组经疏风凉血补肾法(方)治疗,在PD-L1方面,治疗后与治疗前无明显变化,治疗前后比较无统计学意义(P>0.05),与健康组比较无统计学意义(P>0.05)。
6.CITP组经疏风凉血补肾法(方)治疗,在sPD-1表达方面,治疗后较治疗前明显减少,治疗前后比较有显著统计学意义(P<0.01),与健康组比较均有显著统计学意义(P<0.01)。
7.CITP组经疏风凉血补肾法(方)治疗,在IL-2表达方面,治疗后较治疗前明显减少,治疗前后比较有显著统计学意义(P＜0.01)；治疗前后IL-2表达均高于健康组,与健康组相比较均有显著统计学意义(P＜0.01)。
8. CITP组经疏风凉血补肾法(方)治疗,在IL-10表达方面,治疗后较治疗前明显减少,治疗前后比较有统计学意义(P＜0.05)；治疗前后与健康组比较均有显著统计学意义(P＜0.01)。
结论：
CITP免疫功能存在紊乱现象,负性协同刺激分子通路PD-1/PD-L发生异常,sPD-1过度表达,PD-1低表达,抑制信号减弱,导致失去正常抑制的正性协同刺激分子过度表达,促进T淋巴细胞数量增加和活化程度增强,引起抗自身免疫强烈的反应,导致T细胞亚群Th1/Th2出现平衡紊乱、细胞因子分泌异常,从而使活化的B细胞出现异常增加,促进抗血小板相关抗体分泌,引起血小板过度破坏,导致ITP发生。疏风凉血补肾法(方)可调节协同刺激分子的表达,通过上调负性协同刺激分子PD-1的表达,降低sPD-1表达,降低细胞因子IL-2、IL-10的表达水平,调节Th1/Th2细胞间的平衡,抑制自身免疫过度反应,减少抗血小板相关抗体过度分泌引起的血小板大量破坏。因此治疗CITP,可从促进负性协同刺激通路PD-1/PD-L的正常表达,调节T淋巴细胞亚群Th1/Th2的平衡状态,调控相关细胞因子分泌,调节免疫失衡状态等方面出发,深入研究中西医结合治疗CITP的理论依据,具有重要的临床价值。
Object ive
Immune thrombocytopenic purpura (1TP) is an autoimmune bleeding disorder, clinical manifestations of peripheral platelet (PLT) count drops, skin bleeding, purpura, mucous membranes, and (or) internal bleeding and other symptoms, Chinese medicine believes that the disease can be attributed to the "blood","muscle bleed at the nose","spots" and other areas. ITP pathogenesis is not yet fully clear, according to the multi-depth study, as an autoimmune disease, the cellular immune disorder is important in the pathogenesis of ITP addition to the humoral immune, and this field of research is of growing the concern of many. Costimulatory molecules can adjust the degree of lymphocyte activation as an important part of cell-mediated immunity, can continue to remain in the active lymphocytes, but also make lymphocytes to avoid excessive activation of a variety of autoimmune diseases its development, the current study found and co-stimulatory molecule expression closely related to the Imbalance. Costimulatory molecules with positive and negative stars, excessive act-ivation of T lymphocytes, abnormal secretion of a variety of cytokines, often with positive costimulatory molecules excessive expression, which in turn caused by excessive proliferation and activation of B lymphocytes, to promote anti-platelet related antibody secretion, causing excessive platelet destruction; the body negative costimulatory molecules in the activation of T lymphocytes proliferation and cytokine secretion often inhibited. CD4+subsets (Th) cells based on cytokine secretion itself into both Thl and Th2subsets, Thl, secreted IL-2, IFN-gamma and other cytokines, mainly mediated cellular immunity; Th2secretion of IL-4IL-10and other cytokines, mainly mediated humoral immunity; Thl and Th2cytokine secretion can promote their proliferation, but also inhibit each other cytokine secretion, and under certain conditions Thl/Th2function can also be converted to each other. The Th1/Th2balance immune function to maintain normal conditions, the occurrence and development of a variety of autoimmune diseases and its imbalance, abnormal cytokine secretion is closely related.
This study starting from the clinical intervention in the the breeze cooling blood and kidney Law (square) by flow cytometry (Flow Cytometer, FCM) and enzyme-linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA), by detecting patients with peripheral bloodPD-1, PD-L1, SPD-1expression and closely related to the immune the Th1/Th2cytokine IL-2, IL-10' s levels, studied at the molecular level the ITP patients PD-1/PD-L negative synergistic costimulatory pathway expression and T cell function on its mechanism of chronic immune thrombocytopenic purpura (Chronic Immune Thrombocytopenic Purpura, CITP) pathogenesis. On this basis, the key observation expelling wind cooling blood and kidney (square) intervention to explore the PD1, PD-L1and SPD1relationship between, and further explore the negative co-stimulatory pathway PD-1/PD-L relationship with ITP, ITP rich theory of Chinese medicine treatment, to explore the theory of Chinese medicine effective in treating autoimmune diseases.
Methods
Clinical Study
18patients meet the the CITP diagnostic criteria and inclusion criteria numbered CITP group to dispelling wind Liangxue kidney Act (square) intervention For hormone continued hormone therapy (prednisone,0.5-lmg (kg. d)). Exogenous symptoms, plus relieving drugs.4weeks for a course, each extracted peripheral blood observed after a course of treatment, continuous observation of three courses, to observe the changes in platelet count, peripheral blood costimulatory molecule PD-1, PD-L1, SPD-1expression and cytokine IL-2, IL-10levels.
Results
Clinical Experiment Study results
1. CITP platelet count, PD-1expression was significantly lower than the healthy group (P<0.01), SPD-1, IL-2, IL-10expression was significantly higher than in the healthy group (P<0.01) the CITP groups and health groupno significant difference (P>0.05) in the expression of PD-L1.
2. CITP group SPD-1, IL-2, IL-10three positive correlation (correlation coefficient r tends at+1, P all P<0.01).
3. CITP group, the breeze cooling blood and kidney Act (square) after treatment, no significant change in the PLT compared with pre-treatment, the two groups was not statistically significant (P>0.05), compared with healthy controls, before and after treatment were statistically significant (P<0.01).
4. CITP group treatment by the the Shufeng Liangxue kidney Act (square), PD-1expression is increased compared with before treatment, the two groups did not reach statistical significance (P>0.05), treatment before PD-1expression and health groups reached statistical significance(P<0.01); the treatment PD-1expression compared with healthy controls did not reach statistical significance (P>0.05);
5. CITP group treatment by the the Shufeng Liangxue kidney Act (square), PD-L1, after treatment and before treatment, no significant changes in the two groups was not statistically significant (P>0.05), the two groups compared with healthy controls was not statisticallysignificant (P>0.05).
6. CITP group treatment by the the Shufeng cooling blood and kidney Law (square), SPD-1expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.01); two groups are compared with healthy controlsstatistically significant (P<0.01).
7. CITP group treatment by the the Shufeng Liangxue kidney Act (square), IL-2expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.01); before and after treatment were compared with the healthy group, were significantly statistically significant (P<0.01).
8. CITP group, Shufeng Liangxue kidney Act (square) treatment, IL-10expression after treatment than before treatment significantly reduced the two groups was statistically significant (P<0.05); before and after treatment compared with healthy controls have significantlystatistically significant (P<0.01).
Conclusion
The CITP immune function disorder phenomenon, negative costimulatory the molecular pathways PD-1/PD-L abnormal, SPD-1over-expression of PD-1low expression, inhibition of signal weakened, resulting in loss of normal inhibition of positive costimulatory molecules overexpression, and promote the increase in the number and enhance the degree of activation of T lymphocytes, causing a strong reaction to anti-autoimmune, leading to T cell subsets the Thl/Th2balance disorders, abnormal cytokine secretion, so that the abnormal increase in activated B cells, promote anti-platelet-associated antibody secretion, causing excessive destruction of platelets, resulting in ITP occurs The breeze cooling blood and kidney (square) regulate the expression of costimulatory molecules, negative costimulatory molecule PD-1expression by up-regulating the expression of SPD-1, reduce the cytokines1L-2,1L-10the expression level of adjustment the balance between Thl/Th2cells suppress autoimmune overreaction, to reduce the antiplatelet antibody excessive secretion induced platelet lot of damage. Therefore, treatment CITP, from to promote negative costimulatory pathway PD-1/PD-L normal expression, regulation of T lymphocyte subsets Thl/Th2balance, regulation cytokine secretion, regulate immune imbalance departure, depth study of the theoretical basis for Integrat ive Medicine treatment of CITP has important cli nical value.
引文
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