CAJ | 학술논문

目的初步探讨免疫相关性全血细胞减少(IRP)患者外周血记忆B淋巴细胞(Bm)亚群的临床意义.方法以86例IRP患者和11名健康志愿者为研究对象,采用流式细胞术检测外周血Bm水平[CD5+CD19+CD27+细胞比率]、骨髓单个核细胞膜抗体类型,分析其与临床疗效的关系.结果①52例初治患者均接受常规免疫抑制治疗(43例明显显效).34例复发患者中16例接受利妥昔单抗(RTX)治疗(14例明显显效),18例接受常规免疫抑制治疗(13例明显显效).②外周血Bm水平比较:复发组患者水平[(23.00±7.04)％]显著高于初治组[(1.81±0.97)％]及正常对照组[(1.75±0.55)％](P值均＜0.05),初治组与正常对照组差异无统计学意义(P＞0.05);RTX治疗组和常规免疫抑制剂治疗组患者治疗前Bm水平比较,两组差异无统计学意义(P＞0.05);治疗明显显效后,RTX治疗组Bm水平[(0.22±0.21)％]显著低于常规免疫抑制治疗组[(22.30±10.09)％](P＜0.05).复发组患者经RTX治疗后,有效组和无效组患者Bm水平较治疗前均显著减低,但两组差异无统计学意义(P＞0.05).初治组患者治疗显效后复发者初诊时Bm水平[(3.22±0.67)％]较未复发者[(1.20±0.58)％]明显升高(P＜0.05).③复发患者骨髓单个核细胞膜抗体类型以IgG(82.4％)为主,初治患者以IgM(69.2％)为主.结论外周血Bm可能与IRP患者病情复发有关;Bm对RTX治疗敏感.
목적 초보탐토면역상관성전혈세포감소(IRP)환자외주혈기억B림파세포(Bm)아군적림상의의.방법 이86례IRP환자화11명건강지원자위연구대상,채용류식세포술검측외주혈Bm수평[CD5+CD19+CD27+세포비솔]、골수단개핵세포막항체류형,분석기여림상료효적관계.결과①52례초치환자균접수상규면역억제치료(43례명현현효).34례복발환자중16례접수리타석단항(RTX)치료(14례명현현효),18례접수상규면역억제치료(13례명현현효).②외주혈Bm수평비교:복발조환자수평[(23.00±7.04)％]현저고우초치조[(1.81±0.97)％]급정상대조조[(1.75±0.55)％](P치균＜0.05),초치조여정상대조조차이무통계학의의(P＞0.05);RTX치료조화상규면역억제제치료조환자치료전Bm수평비교,량조차이무통계학의의(P＞0.05);치료명현현효후,RTX치료조Bm수평[(0.22±0.21)％]현저저우상규면역억제치료조[(22.30±10.09)％](P＜0.05).복발조환자경RTX치료후,유효조화무효조환자Bm수평교치료전균현저감저,단량조차이무통계학의의(P＞0.05).초치조환자치료현효후복발자초진시Bm수평[(3.22±0.67)％]교미복발자[(1.20±0.58)％]명현승고(P＜0.05).③복발환자골수단개핵세포막항체류형이IgG(82.4％)위주,초치환자이IgM(69.2％)위주.결론외주혈Bm가능여IRP환자병정복발유관;Bm대RTX치료민감.
Objective To detect memory B lymphocyte (Bm) in peripheral blood (PB) of immune-related pancytopenia (IRP).Methods 86 patients with IRP and 11 health volunteers were enrolled in this study.Bm (CD5 + CD19 + CD27 +) and bone marrow mononucleated cell antibodies (BMMNC-Ab) were determined via fluorescence-activated cell sorting,and clinical outcomes of these patients were analyzed.Results ①43 initial patients achieved obvious remission in all 52 initial cases after conventional immunosuppression therapy.16 relapsed patients with IRP received Rituximab (RTX) and 14 cases achieved obvious remission,among which 7 cases were refractory to conventional immunosuppression therapy,5 cases exhibited obvious remission,and 2 cases did not respond.Other 18 relapsed cases received conventional immunosuppression therapy and 13 cases achieved obvious remission.①The level of Bm in PB in 52 initial patients with IRP was (1.81±0.97)％,and no significant difference was observed between the initial patients and health volunteers (1.75±0.55)％ (P＞0.05).The level of Bm in PB in 34 relapsed patients with IRP was obviously higher than that in the initial IRP patients and health volunteers (P＜0.05).Significant difference was observed in the level of Bm in PB in 16 relapsed IRP patients between pre-therapy and post-therapy with RTX (P＜0.05).No statistical difference was found between the remission and no-response groups in relapsed patients treated with RTX.RTX regimen produced more effective outcome than conventional immunosuppression therapy,which better eliminated Bm than the latter (P＜0.05).Initial patients with IRP who relapsed within a two-year follow-up period had a lower level of Bm in PB compared with unrelapsed patients (P＜0.05).Majority of BMMNC-Ab antibodies in relapsed patients were IgG (82.4％) and IgM (69.2％) autoantibodies in patients with initial IRP.Conclusions The level of Bm in PB was associated with relapsed patients with IRP.Bm did not respond to conventional immunosuppression therapy,but responded to RTX.