[摘要] 目的 探讨P–糖蛋白（P–glycoprotein，P–gp）及T淋巴细胞亚群在原发免疫性血小板减少症（primary immune thrombocytopenia，ITP）患儿中的表达水平及与临床疗效的相关性。方法 选取2022年6月至2024年6月石河子大学第一附属医院确诊的ITP患儿120例为研究对象，收集患儿的临床资料、T淋巴细胞亚群及P–gp检验结果。根据治疗方案及治疗效果的不同，将其分为糖皮质激素（glucocorticoid，GC）治疗组（GC有效组、GC无效组）和静脉注射免疫球蛋白（intravenous immunoglobulin，IVIg）治疗组（IVIg有效组、IVIg无效组）；比较各组患儿P–gp及T淋巴细胞亚群水平。结果 P-gp与CD8⁺呈正相关，与CD4⁺/CD8⁺呈负相关（Plt;0.05）。GC有效组患儿的P–gp及CD8⁺均显著低于GC无效组，CD4⁺/CD8⁺显著高于GC无效组（Plt;0.05），但其CD4⁺比较差异无统计学意义（Pgt;0.05）。IVIg有效组和IVIg无效组患儿的P–gp、CD4⁺、CD8⁺及CD4⁺/CD8⁺比较差异均无统计学意义（Pgt;0.05）。结论 ITP患儿的P–gp与T淋巴细胞亚群表达水平存在相关性，P–gp及CD8⁺表达水平增高提示GC治疗可能无效，检测P–gp及T淋巴细胞亚群水平可帮助预测GC治疗反应性并判断预后。

[关键词] 原发免疫性血小板减少症；P-糖蛋白；T淋巴细胞亚群；糖皮质激素

[中图分类号] R725" """"[文献标识码] A """""[DOI] 10.3969/j.issn.1673-9701.2025.19.004

Clinical study on P-glycoprotein and T lymphocyte subsets in children with ITP

ZHANG Bihan， NING Jianying

Department of Pediatrics， the First Affiliated Hospital of Shihezi University， Shihezi 832008， Xinjiang， China

[Abstract] Objective To discuss the correlation between the expression of P-glycoprotein （P-gp） and T lymphocyte subsets with clinical efficacy in children with primary immune thrombocytopenia （ITP）. Methods A total of 120 children diagnosed with ITP in the First Affiliated Hospital of Shihezi University from June 2022 to June 2024 were selected as research subjects. The clinical data， T lymphocyte subsets and P-gp test results were collected. According to differences in treatment plans and therapeutic effects， they were divided into glucocorticoid （GC） treatment group （GC-effective group， GC-ineffective group） and intravenous immunoglobulin （IVIg） treatment group （IVIg-effective group， IVIg-ineffective group）. The levels of P-gp and T lymphocyte subsets were compared within each group. Results P-gp was positively correlated with CD8⁺ and negatively correlated with CD4⁺/CD8⁺ （Plt;0.05）. The P-gp and CD8⁺ of children in GC-effective group were significantly lower than those in GC-ineffective group， and CD4⁺/CD8⁺ ratio was significantly higher than that in GC-ineffective group （Plt;0.05）. However， there was no statistically significant difference in CD4⁺ between two groups of children （Pgt;0.05）. There were no statistically significant differences in P-gp， CD4⁺， CD8⁺ and CD4⁺/CD8⁺ between IVIg-effective group and IVIg-ineffective group （Pgt;0.05）. Conclusion The expression levels of P-gp and T lymphocyte subsets are associated in children with ITP. High expression levels of P-gp and CD8⁺ suggest that GC therapy may be ineffective. Monitoring the level of P-gp and T lymphocyte subsets may help predict GC treatment responsiveness in pediatric ITP patients.

[Key words] Primary immune thrombocytopenia; P-glycoprotein; T lymphocyte subsets; Glucocorticoid

儿童原发免疫性血小板减少症（primary immune thrombocytopenia，ITP）是儿童期常见的自身免疫性出血性疾病，1～5岁多见；多数患儿对一线治疗反应良好，血小板计数在诊断后12个月内可恢复正常，但仍有部分患儿反应不佳，进展为慢性难治性ITP，具体原因尚未完全阐明^[1-2]。目前儿童ITP的一线治疗方案为糖皮质激素（glucocorticoid，GC）与免疫球蛋白。静脉注射免疫球蛋白（intravenous immunoglobulin，IVIg）可快速提升血小板计数，但价格昂贵且存在传播输血相关疾病的风险。对不需要紧急处理的活动性出血患儿，可在完善骨髓穿刺检查后选择GC治疗；……