中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
8期
719-723
,共5页
王一浩%付蓉%刘惠%王红蕾%张田%丁少雪%张江勃%高珊%刘春燕
王一浩%付蓉%劉惠%王紅蕾%張田%丁少雪%張江勃%高珊%劉春燕
왕일호%부용%류혜%왕홍뢰%장전%정소설%장강발%고산%류춘연
免疫记忆%免疫相关%全血细胞减少
免疫記憶%免疫相關%全血細胞減少
면역기억%면역상관%전혈세포감소
Immunologic memory%Immune-related%Pancytopenia
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.
目的 初步探討免疫相關性全血細胞減少(IRP)患者外週血記憶B淋巴細胞(Bm)亞群的臨床意義.方法 以86例IRP患者和11名健康誌願者為研究對象,採用流式細胞術檢測外週血Bm水平[CD5+CD19+CD27+細胞比率]、骨髓單箇覈細胞膜抗體類型,分析其與臨床療效的關繫.結果①52例初治患者均接受常規免疫抑製治療(43例明顯顯效).34例複髮患者中16例接受利妥昔單抗(RTX)治療(14例明顯顯效),18例接受常規免疫抑製治療(13例明顯顯效).②外週血Bm水平比較:複髮組患者水平[(23.00±7.04)%]顯著高于初治組[(1.81±0.97)%]及正常對照組[(1.75±0.55)%](P值均<0.05),初治組與正常對照組差異無統計學意義(P>0.05);RTX治療組和常規免疫抑製劑治療組患者治療前Bm水平比較,兩組差異無統計學意義(P>0.05);治療明顯顯效後,RTX治療組Bm水平[(0.22±0.21)%]顯著低于常規免疫抑製治療組[(22.30±10.09)%](P<0.05).複髮組患者經RTX治療後,有效組和無效組患者Bm水平較治療前均顯著減低,但兩組差異無統計學意義(P>0.05).初治組患者治療顯效後複髮者初診時Bm水平[(3.22±0.67)%]較未複髮者[(1.20±0.58)%]明顯升高(P<0.05).③複髮患者骨髓單箇覈細胞膜抗體類型以IgG(82.4%)為主,初治患者以IgM(69.2%)為主.結論外週血Bm可能與IRP患者病情複髮有關;Bm對RTX治療敏感.
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.