人免疫球蛋白联合地塞米松对儿童急性ITP血清NF-κB、ADAM17及Treg/Th17细胞因子的影响

Effect of human immunoglobulin combined with dexamethasone on serum NF-κB, ADAM17, and Treg/Th17 cytokines in children with acute immune thrombocytopenia

摘要:

目的 分析人免疫球蛋白联合地塞米松治疗儿童急性免疫性血小板减少症（ITP）的临床疗效，并分析其对血清核因子-κB（NF-κB）、解整合素金属蛋白酶17（ADAM17）及调节性T细胞/辅助性T细胞17（Treg/Th17）细胞因子的影响。方法 选取2023年8月—2025年9月秦皇岛市妇幼保健院收治90例的急性ITP患儿为研究对象。依据随机数表法将患儿分为研究组和对照组，各45例。对照组给予地塞米松治疗，研究组在对照组治疗方案基础上联合应用人免疫球蛋白治疗。观察两组患儿的疗效、血小板计数（PLT）、血清NF-κB、ADAM17及Treg细胞比例、Th17细胞比例、白细胞介素-17（IL-17）水平变化，以及不良反应情况。结果 研究组总有效率高于对照组（P <0.05）。研究组治疗后PLT高于对照组（P <0.05）；研究组治疗前后PLT的差值大于对照组（P <0.05）。研究组治疗后血清NF-κB、ADAM17水平均低于对照组（P <0.05）；研究组治疗前后血清NF-κB、ADAM17水平的差值均大于对照组（P <0.05）。研究组治疗后Treg细胞比例高于对照组（P <0.05），Th17细胞比例及IL-17水平均低于对照组（P <0.05）。研究组治疗前后Treg细胞比例、Th17细胞比例、IL-17水平的差值均大于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 在急性ITP患儿治疗中，人免疫球蛋白联合地塞米松疗效显著，可提升患儿PLT，降低血清NF-κB、ADAM17水平，有效纠正Treg/Th17细胞免疫失衡，且安全性良好。

Abstract:

Objective To analyze the clinical efficacy of human immunoglobulin combined with dexamethasone in the treatment of acute immune thrombocytopenia (ITP) in children, and to analyze its effect on the levels of serum nuclear factor-κB (NF-κB), a disintegrin and metalloprotease 17 (ADAM17), and the cytokines associated with regulatory T cell/helper T cell 17 (Treg/Th17).Methods A total of 90 children with acute ITP admitted to Qinhuangdao Maternal and Child Health Hospital from August 2023 to September 2025 were selected as study subjects. According to a random number table method, the children were divided into a study group (n = 45) and a control group (n = 45). The control group was treated with dexamethasone, while the study group was treated with human immunoglobulin combined with dexamethasone. The therapeutic efficacy, platelet count (PLT), changes in serum NF-κB and ADAM17 levels, the proportion of Treg cells, the proportion of Th17 cells, interleukin-17 (IL-17) levels, and adverse reactions were observed in the two groups.Results The total effective rate in the study group was higher than that in the control group (P < 0.05). After treatment, the PLT in the study group was higher than that in the control group (P < 0.05). The changes in PLT from before to after treatment in the study group were greater than those in the control group (P < 0.05). After treatment, the serum levels of NF-κB and ADAM17 in the study group were lower than those in the control group (P < 0.05). The changes in serum NF-κB and ADAM17 levels from before to after treatment in the study group were greater than those in the control group (P < 0.05). After treatment, the proportion of Treg cells in the study group was higher than that in the control group (P < 0.05), while the proportion of Th17 cells and the level of IL-17 were lower (P < 0.05). The changes in the proportion of Treg cells, the proportion of Th17 cells, and the level of IL-17 from before to after treatment in the study group were greater than those in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion In the treatment of children with acute ITP, the combination of human immunoglobulin and dexamethasone has a significant therapeutic effect. It can increase the PLT, reduce serum NF-κB and ADAM17 levels, effectively correct the Treg/Th17 immune imbalance, with a good safety profile.