[1]武文琦,闫振宇.原发免疫性血小板减少症免疫机制及免疫治疗的研究进展[J].医学信息,2023,36(13):177-181,187.[doi:10.3969/j.issn.1006-1959.2023.13.040]
 WU Wen-qi,YAN Zhen-yu.Research Progress on Immune Mechanism and Immunotherapy of Primary Immune Thrombocytopenia[J].Journal of Medical Information,2023,36(13):177-181,187.[doi:10.3969/j.issn.1006-1959.2023.13.040]
点击复制

原发免疫性血小板减少症免疫机制及免疫治疗的研究进展()

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年13期
页码:
177-181,187
栏目:
综述
出版日期:
2023-07-01

文章信息/Info

Title:
Research Progress on Immune Mechanism and Immunotherapy of Primary Immune Thrombocytopenia
文章编号:
1006-1959(2023)13-0177-06
作者:
武文琦闫振宇
(1.华北理工大学研究生学院,河北 唐山 063000;2.华北理工大学附属医院血液科,河北 唐山 063000)
Author(s):
WU Wen-qiYAN Zhen-yu
(1.Graduate School of North China University of Science and Technology,Tangshan 063000,Hebei,China;2.Department of Hematology,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,Hebei,China)
关键词:
原发免疫性血小板减少症免疫机制免疫治疗
Keywords:
Primary immune thrombocytopeniaImmune mechanismImmunotherapy
分类号:
R558+.2
DOI:
10.3969/j.issn.1006-1959.2023.13.040
文献标志码:
A
摘要:
原发免疫性血小板减少症(ITP)是一种自身免疫性疾病。ITP的发病机制复杂,其中B细胞、T细胞及DC细胞所致机体免疫功能失调是主要原因。针对不同免疫发病机制,有不同的治疗靶点,免疫抑制剂作为二线性治疗方案应用越来越多。来那度胺和硼替佐米具有免疫作用,已用于恶性血液病的治疗,但对于ITP的疗效有待研究。本文就ITP免疫机制不同方面及不同治疗药物的研究进展进行综述,讨论来那度胺和硼替佐米等药物在ITP治疗中的应用情况,以期为治疗ITP提供相关临床经验。
Abstract:
Primary immune thrombocytopenia (ITP) is an autoimmune disease. The pathogenesis of ITP is complex, among which the immune dysfunction caused by B cells, T cells and DC cells is the main reason. For different immune pathogenesis, there are different therapeutic targets, and immunosuppressants are used more and more as a second-line therapy. Lenalidomide and bortezomib have immunological effects and have been used in the treatment of hematological malignancies, but whether they have efficacy in ITP remains to be studied. This article reviews the research progress of different aspects of ITP immune mechanism and different therapeutic drugs, and discusses the application of drugs such as lenalidomide and bortezomib in the treatment of ITP, in order to provide relevant clinical experience for the treatment of ITP.

参考文献/References:

[1]刘新光,侯明.成人原发免疫性血小板减少症:2019版美国血液学会指南与国际共识报告更新解读[J].中华血液学杂志,2020,41(6):441-445.[2]Kochhar M,Neunert C.Immune thrombocytopenia: A review of upfront treatment strategies[J].Blood Rev,2021,49:100822.[3]Wang L,Fu Y,Chu Y.Regulatory B Cells[J].Adv Exp Med Biol,2020,1254:87-103.[4] 郝立君,许腾,李智伟,等.Breg细胞与Treg细胞在免疫性血小板减少症患者外周血中的表达及临床意义[J].国际检验医学杂志,2021,42(9):1074-1078.[5]狄正霞,耿岩,孙晓琳,等.免疫性血小板减少症患者CD19+B细胞的表达及血清Breg在患者发病中的参与作用[J].中国实验血液学杂志,2019,27(3):911-915.[6]Hayashi T,Nakamae H,Takeda S,et al.Increasing numbers of CD19+ CD24highCD38high regulatory B cells and pre-germinal center B cells reflect activated autoimmunity and predict future treatment response in patients with untreated immune thrombocytopenia[J].Int J Hematol,2021,114(5):580-590.[7]Li X,Zhong H,Bao W,et al.Defective regulatory B-cell compartment in patients with immune thrombocytopenia[J].Blood,2012,120(16):3318.[8]Audia S,Mahévas M,Samson M,et al.Pathogenesis of immune thrombocytopenia[J].Autoimmun Rev,2017,16(6):620-632.[9]Wen R,Wang Y,Hong Y,et al.Cellular immune dysregulation in the pathogenesis of immune thrombocytopenia[J].Blood Coagul Fibrinolysis,2020,31(2):113-120.[10]G?觟zmen S,Karapnar TH,Tüfek?觭i ?魻,et al.B-cell-activating factor, a proliferation inducing ligand and co-stimulatory molecules in the pathogenesis of immune thrombocytopenia in childhood[J].Blood Coagul Fibrinolysis,2016,27(5):494-499.[11]Xu P,Shao X,Ou Y,et al.Neutrophils contribute to elevated BAFF levels to modulate adaptive immunity in patients with primary immune thrombocytopenia by CD62P and PSGL1 interaction[J].Clin Transl Immunology,2022,11(7):e1399.[12]Kamhieh-Milz J,Ghosoun N,Sterzer V,et al.Effect of glucocorticoid treatment on BAFF and APRIL expression in patients with immune thrombocytopenia (ITP)[J].Clin Immunol,2018,188:74-80.[13]Wang Y,Jia X,Zhou L,et al.Increased let-7b-5p is associated with enhanced BAFF-R expression and B cell survival in immune thrombocytopenia[J].Int Immunopharmacol,2021,93:107393.[14]LeVine DN,Brooks MB.Immune thrombocytopenia (ITP): Pathophysiology update and diagnostic dilemmas. Vet Clin Pathol[J].2019,48 Suppl 1:17-28.[15]Lin X,Xu A,Zhou L,et al.Imbalance of T Lymphocyte Subsets in Adult Immune Thrombocytopenia[J].Int J Gen Med,2021,14:937-947.[16]Kostic M,Zivkovic N,Cvetanovic A,et al.CD4+ T cell phenotypes in the pathogenesis of immune thrombocytopenia[J].Cell Immunol,2020,351:104096.[17]何登明.慢性HBV感染不同临床表型的免疫因子表达模式及免疫遗传特征研究[D].重庆:第三军医大学,2013.[18]Li Q,Liu Y,Wang X,et al.Regulation of Th1/Th2 and Th17/Treg by pDC/mDC imbalance in primary immune thrombocytopenia[J].Exp Biol Med (Maywood),2021,246(15):1688-1697.[19]Lyu M,Li Y,Hao Y,et al.CCR6 defines a subset of activated memory T cells of Th17 potential in immune thrombocytopenia[J].Clin Exp Immunol,2019,195(3):345-357.[20]赵红玉,李大启,王娟,等.低剂量西达本胺治疗原发免疫性血小板减少症及其作用机制研究[J].中华血液学杂志,2020,41(4):292-296.[21]Wen R,Wang Y,Hong Y,et al.Cellular immune dysregulation in the pathogenesis of immune thrombocytopenia[J].Blood Coagul Fibrinolysis,2020,31(2):113-120.[22]张小侠,张美玲,杨明珍.CD8+CD28-调节性T细胞及血小板特异性自身抗体免疫性血小板减少症中的表达[J].安徽医科大学学报,2019,54(9):1405-1410.[23]Cao J,Zhang C,Han X,et al.Emerging role of stem cell memory-like T cell in immune thrombocytopenia[J].Scand J Immunol,2019,89(3):e12739.[24]Liu J,Zhang X,Cheng Y,et al.Dendritic cell migration in inflammation and immunity[J].Cell Mol Immunol,2021,18(11):2461-2471.[25]Kapur R,Aslam R,Kim M,et al.Thymic-derived tolerizing dendritic cells are upregulated in the spleen upon treatment with intravenous immunoglobulin in a murine model of immune thrombocytopenia[J].Platelets,2017,28(5):521-524.[26]黎晓鹃,李晓双.ITP患者外周血DC亚群和CD80、CD86表达变化及其与地塞米松治疗效果的相关性分析[J].中国实验血液学杂志,2018,26(6):1752-1756.[27]Zhang X,Wang Y,Zhang D,et al.CD70-silenced dendritic cells induce immune tolerance in immune thrombocytopenia patients[J].Br J Haematol,2020,191(3):466-475.[28]中华医学会血液学分会血栓与止血学组.成人原发免疫性血小板减少症诊断与治疗中国指南(2020年版)[J].中华血液学杂志,2020,41(8):617-623.[29]Salles G,Barrett M,Foà R,et al.Rituximab in B-Cell Hematologic Malignancies: A Review of 20 Years of Clinical Experience[J].Adv Ther,2017,34(10):2232-2273.[30]Zhou Z,Yang R.Rituximab treatment for chronic refractory idiopathic thrombocytopenic purpura[J].Crit Rev Oncol Hematol,2008,65(1):21-31.[31]Deshayes S,Mahévas M,Godeau B.Rituximab and immune thrombocytopenia in adults: The state of knowledge 20 years later[J].Rev Med Interne,2021,42(1):32-37.[32]Mishra K,Kumar S,Jandial A,et al.Real-world Experience of Rituximab in Immune Thrombocytopenia[J].Indian J Hematol Blood Transfus,2021,37(3):404-413.[33]Wang J,Li Y,Wang C,et al.Efficacy and Safety of the Combination Treatment of Rituximab and Dexamethasone for Adults with Primary Immune Thrombocytopenia (ITP): A Meta-Analysis[J].Biomed Res Int,2018,2018:1316096.[34]Tj?覬nnfjord E,Holme PA,Darne B,et al.Long-term outcomes of patients treated with rituximab as second-line treatment for adult immune thrombocytopenia - Follow-up of the RITP study[J].Br J Haematol,2020,191(3):460-465.[35]Liddicoat AM,Lavelle EC.Modulation of innate immunity by cyclosporine A[J].Biochem Pharmacol,2019,163:472-480.[36]Wang T,He X,Ran N,et al.Immunological characteristics and effect of cyclosporin in patients with immune thrombocytopenia[J].J Clin Lab Anal,2021,35(9):e23922.[37]Liu AP,Cheuk DK,Lee AH,et al.Cyclosporin A for persistent or chronic immune thrombocytopenia in children[J].Ann Hematol,2016,95(11):1881-1886.[38]Ashfaq S,Can A.Danazol[M].Treasure Island:StatPearls Publishing,2022.[39]杨亚锋,常渊媛.达那唑治疗老年难治性免疫性血小板减少性紫癜临床疗效及对患者T淋巴细胞影响[J].贵州医药,2022,46(2):215-216.[40]Zulfiqar AA,Novella JL,Mahmoudi R,et al.Treatment in idiopathic thrombocytopenic purpura in the elderly: about a retrospective study. Traitement du purpura thrombopénique immunologique chez les sujets ?覾gés de plus de 65 ans: à propos d’une étude rétrospective[J].Geriatr Psychol Neuropsychiatr Vieil,2016,14(2):151-157.[41]李永辉,沙信山,张桂芳,等.小剂量利妥昔单抗联合地塞米松治疗难治性特发性血小板减少性紫癜[J].江苏医药,2010,36(23):2837-2838.[42]Ogino MH,Tadi P.Cyclophosphamide[M].Treasure Island:StatPearls Publishing,2022.[43]Wang J,Wang B,Sun Z,et al.Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura[J].Exp Ther Med,2019,17(3):2137-2142.[44]Holstein SA,Suman VJ,McCarthy PL.Update on the role of lenalidomide in patients with multiple myeloma[J].Ther Adv Hematol,2018,9(7):175-190.[45]Mortensen TB,Frederiksen H,Marcher CW,et al.Refractory primary immune thrombocytopenia with subsequent del(5q) MDS: complete remission of both after lenalidomide[J].BMJ Case Rep,2017,2017:bcr2016215888.[46]Mohty M,Brissot E,Savani BN,et al.Effects of bortezomib on the immune system: a focus on immune regulation[J].Biol Blood Marrow Transplant,2013,19(10):1416-1420.[47]Li G,Wang S,Li N,et al.Proteasome Inhibition with Bortezomib Induces Apoptosis of Long-Lived Plasma Cells in Steroid-Resistant or Relapsed Immune Thrombocytopaenia[J].Thromb Haemost,2018,118(10):1752-1764.

相似文献/References:

[1]竺 琴,罗 军,向金波.儿童紫癜性肾炎的免疫机制研究[J].医学信息,2020,33(17):50.[doi:10.3969/j.issn.1006-1959.2020.17.015]
 ZHU Qin,LUO Jun,XIANG Jin-bo.Study on the Immune Mechanism of Children’s Purpuric Nephritis[J].Journal of Medical Information,2020,33(13):50.[doi:10.3969/j.issn.1006-1959.2020.17.015]
[2]张东艳,张 森,刘 华.病毒感染相关慢性阻塞性肺病急性加重的免疫机制及潜在靶点研究进展[J].医学信息,2022,35(08):25.[doi:10.3969/j.issn.1006-1959.2022.08.007]
 ZHANG Dong-yan,ZHANG Sen,LIU Hua.Research Progress on Immune Mechanism and Potential Targets of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Associated with Virus Infection[J].Journal of Medical Information,2022,35(13):25.[doi:10.3969/j.issn.1006-1959.2022.08.007]
[3]解艳欢.原发性肾病综合征免疫发病机制研究[J].医学信息,2023,36(20):189.[doi:10.3969/j.issn.1006-1959.2023.20.040]
 XIE Yan-huan.Research on Immune Pathogenesis of Primary Nephrotic Syndrome[J].Journal of Medical Information,2023,36(13):189.[doi:10.3969/j.issn.1006-1959.2023.20.040]
[4]李晓靖,周永明,李 洋,等.外周血NK细胞与原发免疫性血小板减少症相关性的Meta分析[J].医学信息,2024,37(01):72.[doi:10.3969/j.issn.1006-1959.2024.01.013]
 LI Xiao-jing,ZHOU Yong-ming,LI Yang,et al.Meta-analysis of the Correlation Between Peripheral Blood NK Cells and Primary Immune Thrombocytopenia[J].Journal of Medical Information,2024,37(13):72.[doi:10.3969/j.issn.1006-1959.2024.01.013]
[5]郑程莉,昌 菁,朱文伟.基于数据挖掘的中医药治疗儿童原发免疫性血小板减少症的临床用药规律研究[J].医学信息,2025,38(08):1.[doi:10.3969/j.issn.1006-1959.2025.08.001]
 ZHENG Chengli,CHANG Jing,ZHU Wenwei.Study on the Clinical Medication Rules of Traditional Chinese Medicine in the Treatment of Primary Immune Thrombocytopenia in Children Based on Data Mining[J].Journal of Medical Information,2025,38(13):1.[doi:10.3969/j.issn.1006-1959.2025.08.001]
[6]原雪芳,冯永海,苗少一.肠道微生物群与多脏器轴的免疫调控机制及其在危重症患者中的作用[J].医学信息,2025,38(20):186.[doi:10.3969/j.issn.1006-1959.2025.20.040]
 YUAN Xuefang,FENG Yonghai,MIAO Shaoyi.Immune Regulation Mechanism of Gut Microbiota and Multiple Organ Axisand its Role in Critically Ill Patients[J].Journal of Medical Information,2025,38(13):186.[doi:10.3969/j.issn.1006-1959.2025.20.040]

更新日期/Last Update: 1900-01-01