多发性硬化患者外周血CD8^＋CD28^-调节性T细胞的变化

Alterations in levels of CD8^＋ CD28^- regulatory T cell in the peripheral blood of multiple sclerosis patients

目的探讨多发性硬化（MS）患者外周血CD8^＋CD28-T细胞数量的变化及临床意义。方法采用前瞻性病例对照研究，收集自2005年10月至2008年8月间在温州医学院附属第一医院神经专科病门诊或病房治疗的处于急性活动期的复发缓解型MS患者51例，均符合2005年修改的Me-Donald诊断标准。所有住院患者均给予甲基强的松龙1．0g／d，连续使用5d后改为强的松60mg／d，12d后减量，总疗程不超过6周，对14例MS患者进行治疗前后的动态观察。以20例健康体检者为对照组（NC组），MS组和NC组在年龄、性别构成上差异无统计学意义。采用流式细胞技术检测外周血CD8^＋CD28^-，CD8^＋CD28^＋，CD8^＋及CD4^＋CD8^-T细胞的百分比。两组间均数比较采用独立样本t检验，治疗前后比较采用配对样本t检验，相关性分析采用Pearson相关检验。结果急性活动期MS组CD8^＋CD28^-T细胞的百分比为（18．48±9．89）％，低于NC组的（24．48±4．86）％（P〈0．01），但CD8^＋CD28^＋T细胞百分比为（12．23±4．31）％，高于NC组的（8．55±3．49）％（P〈0．01），CD8^＋T细胞的百分比两组比较差异无统计学意义（P〉0．05）；MS组CD8^＋CD28^-与CD4^＋CD8^-T细胞的百分比呈负相关性（r=-0．488，P〈0．01）；MS患者激素治疗后CD8^＋CD28^-和CD8^＋CD28^＋T细胞百分比与治疗前相比差异无统计学意义（均P〉0．05），且治疗后CD8^＋CD28^-T细胞百分比（16．22±4．25）％低于NC组（P〈0．01），CD8^＋CD28^＋T细胞百分比（13．04±4．23）％高于NC组（P〈0．01）。结论CD8^＋CD28^-T细胞数目的减少参与了MS的病理过程，并可能通过调节CD4^＋T细胞起作用；MS急性期激素治疗并不能恢复CD8^＋CD28-T细胞的数目，激素可能是通过其他途径发生作用。

Objective To investigate the levels of peripheral blood CD8^＋ CD28^- regulatory lymphocytes and their clinical values in the patients with multiple sclerosis（MS）. Method From October 2005 to August 2008, 51 patients with active relapsing-remitting MS were enrrolled from Department of Neurology of the First Affiliated Hospital of Wenzhou Medical College. The diagnostic criteria for MS were the 2005 revisions to the ＂McDonald criteria＂. All the admitted patients received 1 g of methylprednisolone per day intravenously for 5 days, followed by 60 mg prednisone per day orally for 12 days, and tapered in 6 weeks. Fourteen patients were reevaluated after corticosteroid therapy. Twenty healthy individuals ,as normal controls,matched for age and sex with the MS patients were also enrolled in this study. The percentages of peripheral blood T cells （CD8^ ＋ CD28^- , CD8^＋ CD28^＋ , CD8^＋ , CD^4 ＋ CD8^ - ） were measured by flow cytometric analysis. Parametric statistical analysis were performed using standard methods, and linear regression analysis was conducted using Pearson correlation test. Resuits （ 1 ） Compared with controls, the patients with active MS had significantly lower percentage of CD8^＋ CD28 -T ceils [（18.48± 9.89）% vs. （24.48 ± 4.86）%, P 〈 0.01], and higher percentage of CD8^＋ CD28＋ T cells [ （ 12.23 ± 4.31 ） % vs. （8.55 ±3.49） %, P 〈 0.01 ]. （2）The percentage of CD8^＋ CD28 - T cells was negatively correlated with that of CD4^＋ CD8^＋ T cells （ r = - 0.488, P 〈 0.01）. （3） After corticosteroid therapy, the percentage of peripheral blood CD8^＋ CD28^- / CD8^＋ CD28^＋ T cells didn＇ t significantly decrease or increase in 14 active MS patients （ P 〉 0.05 ）. Conclusions The decrease of peripheral blood CD8^＋ CD28^- regulatory T cells might be associated with the pathogenesis of MS, and CD8^ ＋ CD28^- regulatory T cells perhaps played their roles through CD4 ^＋ T cells. Corticosteroid therapy could not reverse the levels of CD8 ^＋ CD28^- T ceils.