骨髓增生异常综合征患者细胞免疫功能及可溶性肿瘤坏死因子受体的研究

Study on the cellular immunne function and soluble tumor necrosis factor receptors in patients with myelodysplastic syndrome

目的:研究骨髓增生异常综合征(MDS)外周血T细胞亚群分布及血清、骨髓可溶性肿瘤坏死因子受体1和2(sTNF-R1和sTNF-R2)的水平及其意义。方法:用流式细胞仪检测外周血T淋巴细胞CD3、CD4和CD8的表达,ELISA法检测血清和骨髓sTNF-R1和sTNF-R2的水平。结果:低危组(RA+RAS)的CD3+细胞(70．04±4．25)％明显升高,MDS患者CD4+细胞减低,低危组为(30．77±6．58)％;高危组(RAEB+RAEB-T)为(25．32±7．93)％,MDS患者CD4／CD8比例亦减低,低危组为0．89±0．24;高危组为0．91±0．52,而MDS患者CD8+细胞明显升高,低危组为(34．96±5．43)％;高危组为(29．67±7．38)％。MDS 2种sTNF-R水平均明显升高,低危组sTNF-R1血清为(1 586．13±573．24)ng／L,骨髓为(2 103．42±259．27)ng／L;sTNF-R2血清为(1 445．73±498．22)ng／L,骨髓为(1 961．50±614．53)ng／L;高危组sTNF-R1血清为(2 621．20±546．65)ng／L,骨髓为(3 146．03±412．14)ng／L;sTNF-R2血清为(1 972．34±558．31)ng／L,骨髓为(3 087．12±569．42)ng／L。血清sTNF-R2水平与CD8+细胞呈正相关,与CD4／CD8呈负相关。结论:细胞免疫异常及免疫分子表达异常增高,在MDS发病中起重要作用。

Objective：To investigate T lymphocyte subsets and the levels of soluble tumor necrosis factor receptors （sTNF-R） in patients with myelodysplastic syndrome （MDS） and its clinical significance. Method：The ex pression of CD3,CD4 and CD8 on peripheral lymphocytes was analyzed by flow cytometry. The levels of sTNF-R1 and sTNF-R2 in serum and bone marrow were measured by ELISA. Result：The percentage of CD3^＋ cells [（70.04 ±4.25）%] was significantly increased in RA＋RAS. The percentage of CD4^＋ cells [（30.77±6.58）% in RA＋ RAS; （25.32±7.93）% in RAEB＋RAEB-T] and CD4/CD8 ratio （0.89±0.24 in RA＋RAS; 0.91±0.52 in RAEB＋ RAEB-T） were remarkably decreased, while the percentage of CD8^＋ cells was significantly increased [（34.96±5.43）% in RA＋RAS; （29.67±7.38）% in RAEB＋RAEB-T] in MDS patients. The levels of the two sTNF-R in MDS patients were elevated [ sTNF-R1 in RA ＋ RAS （1 586.13 ± 573.24） ng/L （PB）, （ 2 103.42 ± 259.27） ng/L （BM） ; sTNF-R2 in RA＋RAS （1 445.73±498.22） ng/L （PB）, （1 961.50±614.53） ng/L （BM） sTNF-R1 in RAEB＋RAEB-T （2 621.20±546.65） ng/L （PB）, （3 146.03±412.14） ng/L （BM） ; sTNF-R2 in RAEB＋RAEB-T （1 972.34±558.31） ng/L （PB）, （3 087.12±569.42） ng/L （BM）]. The levels of sTNF-R2 in serum positively correlated to CD8^＋ cells but negatively correlated to CD4/CD8. Conclusion：The cellular immune dysfunction and abnormally elevated immunologieally active molecules might play an important role in the pathogenesis of MDS.