临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2015年
6期
628-632
,共5页
石秀珍%王会平%潘莹%王芝涛%张家奎%翟志敏
石秀珍%王會平%潘瑩%王芝濤%張傢奎%翟誌敏
석수진%왕회평%반형%왕지도%장가규%적지민
贫血,再生障碍性%T 淋巴细胞亚群%免疫活性
貧血,再生障礙性%T 淋巴細胞亞群%免疫活性
빈혈,재생장애성%T 림파세포아군%면역활성
anemia,aplastic%T-lymphocyte subsets%immunocompetence
目的：检测再生障碍性贫血(AA)患者外周血 CD4+ CD25+ Treg 细胞和 T 细胞亚群的表达情况,分析两者与 AA 病情严重程度及免疫抑制剂疗效的关系,为评估 AA 患者病情、选择合理治疗方案提供依据。方法以46例接受免疫抑制剂(单用环孢素 A)治疗的初诊 AA 患者和26例正常健康体检者为研究对象,采用多参数流式细胞术检测其细胞免疫功能,包括 T 细胞亚群、CD4+ CD25+ Treg 细胞和效应性 T 细胞,按照正常对照组水平将患者分组：CD127 low/CD127 high 比值正常型和降低型；CD4+/CD8+比值正常型、倒置型及正置型,分析比较各亚型与病情、疗效之间的关系,并进一步比较 CD4+ CD25+ Treg 细胞与 T 细胞亚群在评估 AA 患者免疫状态中的优劣。结果①CD127 low/CD127 high 比值正常型占28.3%(13/46),降低型占71.7%(33/46)；重型 AA(SAA)与非重型 AA(NSAA)两组降低型患者所占比例分别为89.5%(17/19)、59.3%(16/27),差异有统计学意义(χ2=5.022,P <0.05)；单用环孢素治疗,总有效率为48.1%(13/27),有效者降低型比例92.3%(12/13),明显高于无效者降低型比例50.0%(7/14)(χ2=3.395,P <0.05)。②CD4+/CD8+比值正常型占39.1%(18/46),倒置型占39.1%(18/46),正置型占21.7%(10/46)；SAA 与 NSAA 两组中按 CD4+/CD8+分型,两组间构成比例差异无统计学意义(χ2=0.211,P >0.05)；单用环孢素治疗,有效和无效者按 CD4+/CD8+分3种亚型,分别占有效者46.2%(6/13)、46.2%(6/13)、7.7%(1/13),无效者为35.7%(5/14)、28.6%(4/14)、35.7%(5/14),差异无统计学意义(χ2=2.983,P >0.05)。③CD4+ CD25+ Treg和 T 细胞亚群监测 AA 患者免疫状态异常的阳性率分别为71.7%(33/46)和60.9%(28/46),CD4+ CD25+ Treg 监测免疫状态异常的敏感性高于 T 细胞亚群(χ2=4.290,P <0.05)。结论大多数患者存在 CD4+ CD25+ Treg 细胞和(或)T 细胞亚群的异常,与 AA 发病机制的免疫异常密切相关；在监测 AA 患者免疫功能异常、评估病情及免疫抑制剂疗效时,CD4+ CD25+ Treg 细胞比 T 细胞亚群更敏感；CD4+ CD25+ Treg 细胞联合 T 细胞亚群的监测对临床了解AA 病情和发病机制、合理用药、提高诊断和治疗水平有重要价值。
目的：檢測再生障礙性貧血(AA)患者外週血 CD4+ CD25+ Treg 細胞和 T 細胞亞群的錶達情況,分析兩者與 AA 病情嚴重程度及免疫抑製劑療效的關繫,為評估 AA 患者病情、選擇閤理治療方案提供依據。方法以46例接受免疫抑製劑(單用環孢素 A)治療的初診 AA 患者和26例正常健康體檢者為研究對象,採用多參數流式細胞術檢測其細胞免疫功能,包括 T 細胞亞群、CD4+ CD25+ Treg 細胞和效應性 T 細胞,按照正常對照組水平將患者分組：CD127 low/CD127 high 比值正常型和降低型；CD4+/CD8+比值正常型、倒置型及正置型,分析比較各亞型與病情、療效之間的關繫,併進一步比較 CD4+ CD25+ Treg 細胞與 T 細胞亞群在評估 AA 患者免疫狀態中的優劣。結果①CD127 low/CD127 high 比值正常型佔28.3%(13/46),降低型佔71.7%(33/46)；重型 AA(SAA)與非重型 AA(NSAA)兩組降低型患者所佔比例分彆為89.5%(17/19)、59.3%(16/27),差異有統計學意義(χ2=5.022,P <0.05)；單用環孢素治療,總有效率為48.1%(13/27),有效者降低型比例92.3%(12/13),明顯高于無效者降低型比例50.0%(7/14)(χ2=3.395,P <0.05)。②CD4+/CD8+比值正常型佔39.1%(18/46),倒置型佔39.1%(18/46),正置型佔21.7%(10/46)；SAA 與 NSAA 兩組中按 CD4+/CD8+分型,兩組間構成比例差異無統計學意義(χ2=0.211,P >0.05)；單用環孢素治療,有效和無效者按 CD4+/CD8+分3種亞型,分彆佔有效者46.2%(6/13)、46.2%(6/13)、7.7%(1/13),無效者為35.7%(5/14)、28.6%(4/14)、35.7%(5/14),差異無統計學意義(χ2=2.983,P >0.05)。③CD4+ CD25+ Treg和 T 細胞亞群鑑測 AA 患者免疫狀態異常的暘性率分彆為71.7%(33/46)和60.9%(28/46),CD4+ CD25+ Treg 鑑測免疫狀態異常的敏感性高于 T 細胞亞群(χ2=4.290,P <0.05)。結論大多數患者存在 CD4+ CD25+ Treg 細胞和(或)T 細胞亞群的異常,與 AA 髮病機製的免疫異常密切相關；在鑑測 AA 患者免疫功能異常、評估病情及免疫抑製劑療效時,CD4+ CD25+ Treg 細胞比 T 細胞亞群更敏感；CD4+ CD25+ Treg 細胞聯閤 T 細胞亞群的鑑測對臨床瞭解AA 病情和髮病機製、閤理用藥、提高診斷和治療水平有重要價值。
목적：검측재생장애성빈혈(AA)환자외주혈 CD4+ CD25+ Treg 세포화 T 세포아군적표체정황,분석량자여 AA 병정엄중정도급면역억제제료효적관계,위평고 AA 환자병정、선택합리치료방안제공의거。방법이46례접수면역억제제(단용배포소 A)치료적초진 AA 환자화26례정상건강체검자위연구대상,채용다삼수류식세포술검측기세포면역공능,포괄 T 세포아군、CD4+ CD25+ Treg 세포화효응성 T 세포,안조정상대조조수평장환자분조：CD127 low/CD127 high 비치정상형화강저형；CD4+/CD8+비치정상형、도치형급정치형,분석비교각아형여병정、료효지간적관계,병진일보비교 CD4+ CD25+ Treg 세포여 T 세포아군재평고 AA 환자면역상태중적우렬。결과①CD127 low/CD127 high 비치정상형점28.3%(13/46),강저형점71.7%(33/46)；중형 AA(SAA)여비중형 AA(NSAA)량조강저형환자소점비례분별위89.5%(17/19)、59.3%(16/27),차이유통계학의의(χ2=5.022,P <0.05)；단용배포소치료,총유효솔위48.1%(13/27),유효자강저형비례92.3%(12/13),명현고우무효자강저형비례50.0%(7/14)(χ2=3.395,P <0.05)。②CD4+/CD8+비치정상형점39.1%(18/46),도치형점39.1%(18/46),정치형점21.7%(10/46)；SAA 여 NSAA 량조중안 CD4+/CD8+분형,량조간구성비례차이무통계학의의(χ2=0.211,P >0.05)；단용배포소치료,유효화무효자안 CD4+/CD8+분3충아형,분별점유효자46.2%(6/13)、46.2%(6/13)、7.7%(1/13),무효자위35.7%(5/14)、28.6%(4/14)、35.7%(5/14),차이무통계학의의(χ2=2.983,P >0.05)。③CD4+ CD25+ Treg화 T 세포아군감측 AA 환자면역상태이상적양성솔분별위71.7%(33/46)화60.9%(28/46),CD4+ CD25+ Treg 감측면역상태이상적민감성고우 T 세포아군(χ2=4.290,P <0.05)。결론대다수환자존재 CD4+ CD25+ Treg 세포화(혹)T 세포아군적이상,여 AA 발병궤제적면역이상밀절상관；재감측 AA 환자면역공능이상、평고병정급면역억제제료효시,CD4+ CD25+ Treg 세포비 T 세포아군경민감；CD4+ CD25+ Treg 세포연합 T 세포아군적감측대림상료해AA 병정화발병궤제、합리용약、제고진단화치료수평유중요개치。
Objective To investigate the expression of regulatory T cells(Treg)and T-cell subgroups in patients with aplastic anemia (AA ) and the relationship between Treg and T-cell subgroups and the severity and immunosuppressive effect of AA,and to provide a basis for selecting rational therapy of AA patients.Methods Cellular immune function of 46 AA patients with immunotherapy were analyzed by tricolour fluorescence labeled monoclonal antibody and multiparameter flow cytometry,including T-cell subtypes,CD4 + CD25 + Treg and effective T cells (Teff).The AA patients were divided into normal type of ratio,inverted type of ratio,hypernormal type of ratio according to the ratio of CD4 +/CD8 + cell in healthy control,and the AA patients were divided into normal type of ratio and low type of ratio according to the ratio of Treg/Teff cell in healthy control.Patients'condition and therapeutic effects were investigated between subtypes in patients with AA.Results ① The percentage of the normal type and the low type of CD127 low/CD127 high in all patients was respectively 28.3% (13/46 )and 71.1% (33/46 ).There was significant difference in percentage of Treg/Teff low type between SAA and NSAA,89.5%(1 7/1 9)vs 59.3%(1 6/27) (χ2 = 5.022, P < 0.05 ). The total effective rate was 48.1% (13/27 ) treating AA patients with single immunosuppresive agent cyclosporine A (CsA),and the rate of Treg/Teff low types of the effective patients was significantly higher than the ineffective patients 92.3% (12/13 )vs 50.0% (7/14 ),respectively (χ2 = 6.677,P <0.01).②According to the ratio of CD4 +/CD8 + cells,the percentage of both normal type of ratio and inverted type of ratio in all patients was 39.1%(18/46),the percentage of hypermormal type of ratio was 21.7%(10/46).There was no significant difference on the percentage of CD4 +/CD8 + types between SAA and NSAA(χ2 = 0.21 1,P > 0.05 ). The rate of CD4 +/CD8 + immunological subtypes treating only with CSA between SAA and NSAA was respectively 46.2%(6/13),46.2%(6/13),7.7%(1/13)and 35.7%(5/14),28.6%(4/14),35.7%(5/14)(χ2 =2.983,P >0.05).③The positive rates of CD4 + CD25 + Treg cells and T cell subsets to monitor the abnormal immune status in patients with AA were 71.7% (33/46)and 60.9%(28/46),respectively.The CD4+ CD25 + Treg to monitor abnormal immune status was significantly sensitive than that of T cell subsets (χ2 =4.290,P <0.05).Conclusion The abnormal ratios of CD4 + CD25 + Treg and T-cell subgroups exist in the majority of AA patients,immunologic abnormality may play a role in pathogenesis of the patients with AA.The detection of CD4 + CD25 + Treg in patients with AA was more sensitive than that T-cell subgroups,which may contribute to the evaluation of patients' condition and choice of rational treatment prescription.Detection of CD4 + CD25 + Treg and T-cell subgroups may play an important role in evaluating the patients'condition and pathogenesis,rational drug use,improving the diagnosis and treatment in patients with AA.
