CAJ | 학술논문

目的观察免疫相关性血细胞减少和全血细胞减少(IRH/IRP)患者治疗前后骨髓单个核细胞( BMMNC)端粒酶活性变化,探讨端粒酶活化与该类疾病的关联及临床意义.方法端粒重复序列扩增-酶联免疫吸附法(TRAP-PCR-ELISA)检测108例IRH/IRP患者BMMNC的端粒酶活性,免疫荧光染色观察患者骨髓细胞抗人IgG、FcγⅡ受体(FcγⅡR)、白细胞介素17A(IL-17A)和甘露糖受体(MR)表达,30例缺铁性贫血患者作为疾病对照.结果 IRH/IRP患者治疗前端粒酶活性为0.251 ±0.021,高于疾病对照组(0.062 ±0.031,P＜0.01)；其中HLA-B27+患者高于HLA-B27 -患者(0.270±0.020比0.181 ±0.013,P＜0.05),HLA-B27+ IgG升高的重度IRP患者显著高于HLA-B27 -IgG升高患者(0.341 ±0.016比0.183 ±0.010,P＜0.01).IRH/IRP患者骨髓中可见抗人IgG抗体阳性的幼稚血细胞,IgG升高者骨髓中活化的巨噬细胞(M(ψ))高表达FcγⅡR,HLA-B27+患者骨髓活化的树突细胞和M(ψ)高表达IL-17A和MR.经糖皮质激素联合环孢素A等药物治疗后患者血象恢复时,BMMNC的端粒酶重新失活.结论 IRH/IRP患者骨髓BMMNC端粒酶活性增强,其活化的强度与免疫细胞活化的群体对病变造血细胞病理性损害程度相关,具有同步性和均衡性.
목적 관찰면역상관성혈세포감소화전혈세포감소(IRH/IRP)환자치료전후골수단개핵세포( BMMNC)단립매활성변화,탐토단립매활화여해류질병적관련급림상의의.방법 단립중복서렬확증-매련면역흡부법(TRAP-PCR-ELISA)검측108례IRH/IRP환자BMMNC적단립매활성,면역형광염색관찰환자골수세포항인IgG、FcγⅡ수체(FcγⅡR)、백세포개소17A(IL-17A)화감로당수체(MR)표체,30례결철성빈혈환자작위질병대조.결과 IRH/IRP환자치료전단립매활성위0.251 ±0.021,고우질병대조조(0.062 ±0.031,P＜0.01)；기중HLA-B27+환자고우HLA-B27 -환자(0.270±0.020비0.181 ±0.013,P＜0.05),HLA-B27+ IgG승고적중도IRP환자현저고우HLA-B27 -IgG승고환자(0.341 ±0.016비0.183 ±0.010,P＜0.01).IRH/IRP환자골수중가견항인IgG항체양성적유치혈세포,IgG승고자골수중활화적거서세포(M(ψ))고표체FcγⅡR,HLA-B27+환자골수활화적수돌세포화M(ψ)고표체IL-17A화MR.경당피질격소연합배포소A등약물치료후환자혈상회복시,BMMNC적단립매중신실활.결론 IRH/IRP환자골수BMMNC단립매활성증강,기활화적강도여면역세포활화적군체대병변조혈세포병이성손해정도상관,구유동보성화균형성.
Objective To observe the telomerase activity (TA) in bone marrow mononuclear cell (BMMNC) at pre-therapy and post-therapy in patients with immune related hematocytopenia and immune related pancytopenia (IRH/IRP) so as to explore the relationship between TA and disease process.Methods TA in BMMNC of 108 IRH/IRP patients was detected with telomeric repeat amplification protocol (TRAP)-PCR-ELISA.The expressions of anti-human immunoglobulin IgG,Fcγ Ⅱ receptor (FcγⅡ R),mannose receptor (MR) and interleukin 17A (IL-17A) located on membrane surface were observed by immunofluorescence(IF). A total of 30 iron deficiency anemia patients were selected as case control.Results The TA of 108 IRH/IRP patients were 0.251 ± 0.021. And it increased as compared with the control group of 0.062 ± 0.031 at pre-therapy (P ＜ 0.01 ).The HLA-B27+ patients among them was 0.270 ± 0.020 while HLA-B27 - patients 0.181 ± 0.013 (P ＜ 0.05).And HLA-B27 + IgG elevated IRP was 0.341 ±0.016 and HLA-B27-IgG elevated 0.183 ±0.010,the difference of TA was significant between two groups ( P ＜ 0.01 ). IgG antibody positive immature hemocyte could be observed in marrow of IRH/IRP patients,and FcγⅡ R was expressed highly on those activated macrophage ( M(ψ) ) in bone marrow. Both IL-17A and MR were expressed on activated dendritic cells and M(ψ) in marrow of HLA-B27 + patients.After the therapy of glucocorticoids associated with cyclosporine A and other drugs,the patient' s hemogram recovered and the telomerase in BMMNC were re-devitalized. Conclusions The TA of the BMMNC in marrow of IRH/IRP patients is increased, and it shows a close relation between apoptotic degree of hematopoietic cell and the activation of immunocytes. In IRH/IRP,synchronism and equilibrium exist between BMMNC apoptosis and TA.