الفهرس 
IMMUNE THROMBOCYTOPENIC PURPURA (ITP)Only 14 pages are availabe for public view
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Abstract
I
mmune thrombocytopenic purpura (ITP) is a common immune- mediated bleeding disorder in which platelets are opsonized by autoantibodies and prematurely destroyed by RES.
Impaired platelet production and T cell–mediated effects also play a role in the pathogenesis of the disease. Dysfunctional cellular immunity is evaluated by the level of the cytokines at the site of immune activation.
Interleukin-10 is an important immunoregulatory cytokine mainly produced by macrophages, monocytes, T cells, B cells, dendritic cells, mast cells and eosinophils. As a (Th2) cell-derived cytokine, IL-10 has been shown to inhibit the secretion of Th1 cell derived cytokines, limit the inflammatory responses and regulate the differentiation and proliferation of several immune cells such as T cells, B cells, natural killer cells and mast cells.
This study aimed to investigate the role of serum level of IL-10, as a marker for prediction of ITP chronic progression in children. We applied measuring serum level of IL10 by ELISA technique.
This study included 20 newly diagnosed children with ITP in whom serum interleukin 10 level was assessed at the onset of the disease and reassessed after either remission or 6 months after onset and persistence of ITP, serum IL- 10 was assessed in 8 children with chronic ITP and in another 20 age- and sex- matched healthy controls.
There was a significant increase in initial and follow up IL-10 in acute patients than controls and chronic patients, while there was a significant decrease in IL-10 in chronic ITP patients than controls.
There was a highly statistically significant increasein follow up IL-10 (P<0.01) between patients with remission and patients with persistent course.
There was a significant correlation between follow up IL10 level and the response to treatment with oral steroids and a highly significant relation with IV steroids.
IL10 could have a diagnostic utility in acute ITP with cut off value > 1 pg/ml, 91.67 % sensitivity, 87.50 % specificity for IL10.
In conclusion, it is clear that high IL-10 levels were carried in children with a remission course of the disease in agreement with the role of this cytokine in immunotolerance. Therefore, the assessment of serum levels of IL-10 in ITP children at the onset of the disease and after 6 months may represent a promising indicator of its clinical progression and that IL-10 levels might represent a useful predictive biomarker of the disease course.
RECOMMENDATIONS
1. We recommend measurement of IL10 at the onset of ITP disease and after 6 months to predict the chronic progression of the disease.
2. Further prospective follow up studies on a larger number of patients are needed to assess the role of IL10 as a predictive marker for the course of ITP.
3. It is better to study TH1 / TH2 cytokine profile, instead of studying a single cytokine, to evaluate the imbalance between TH1 / TH2 cells and its role in the pathogenesis of the disease.
4. Measurement of IL10 level in other autoimmune diseases to document its role in their pathogenesis and prognosis.