急性髓系白血病患者外周血CD4^＋CD25^highFOXP3^＋调节性T细胞变化及临床意义

Changes of CD4^+CD25^(high)FOXP3^+ regulatory T cells in peripheral blood of patients with acute myelogenous leukemia and its clinical significances

目的:观察急性髓系白血病(Acute myelogenous leukemia,AML)患者外周血中调节性T细胞(Regulatory Tcells,Treg细胞)的变化,探讨其在AML发病中的作用及临床意义。方法:应用流式细胞术检测31例初诊AML患者(初诊组)、23例经化疗取得完全缓解患者(CR组)及20例健康人群(对照组)外周血CD4+CD25highFOXP3+Treg细胞、CD4+FOXP3+T细胞占CD4+细胞的比例,同时还分析了外周血CD4+/CD8+比值、NK细胞及血清乳酸脱清酶(LDH)水平。结果:与对照组相比较,AML患者初诊组及CR组外周血CD4+CD25highFOXP3+Treg细胞和CD4+FOXP3+T细胞均升高(P<0.01)。与初诊组相比较,CR组CD4+CD25highFOXP3+Treg细胞无显著降低(P>0.05),CD4+FOXP3+T细胞明显下降(P<0.01)。CD4+CD25highFOXP3+Treg细胞的升降与CD4+FOXP3+T细胞呈正相关(r=0.86;P<0.01)。CD4+CD25highFOXP3+Treg细胞及CD4+FOXP3+T细胞比例与CD4+/CD8+比值呈负相关(r分别为-0.54、-0.52;P<0.01)、与NK细胞比例呈负相关(r分别为-0.41、-0.43;P<0.05),而与LDH水平呈正相关(r分别为0.51、0.57;P<0.05)。结论:CD4+CD25highFOXP3+Treg细胞增多可能是AML患者免疫功能受抑的重要原因之一,其变化对于AML的预后判断有一定的意义。CD4+FOXP3+T细胞的作用类似于CD4+CD25highFOXP3+Treg细胞,其在AML疗效评价方面可能更有价值。

Objective： To observe the changes of CD4^＋CD25^highFOXP3^＋ regulatory T cells （Treg cells） in peripheral blood of patients with acute myelogenous leukemia （AML） in order to reveal the role of Treg cells in the pathogenesis of AML and to evaluate its clinical significance.Methods：The flow cytometry was used to evaluate the proportion of CD4^＋CD25^highFOXP3^＋ Treg cells and CD4^＋ FOXP3^＋ T cells in the peripheral blood of 31 patients with AML who were newly diagnosed （ newly diagnosed group）, 23 patients with AML who achieved complete remission （CR group） and 20 healthy donors （control group）. CD^4＋ ＋/CD8^＋ ratio, the proportion of NK cells and the level of lactate dehydrogenase （LDH） were also analyzed. Results：Compared with that of control group,the proportion of CD4^＋CD25^highFOXP3^＋ Treg cells and CD4^＋ FOXP3^＋ T cells in newly diagnosed group were significantly increased （ P 〈 0.01 ）. Compared with that of the newly diagnosed group,the proportion of CD4^＋CD25^highFOXP3^＋ Treg cells in CR group was not significantly decreased （ P 〉 0.05）, while that of CD4^＋ FOXP3^＋ T cells was decreased （ P 〈 0. 01 ）. The proportion of CD4^＋CD25^highFOXP3^＋ Treg cells was positively correlated with the proportion of CD4^＋ FOXP3^＋ T cells （r = 0.86; P 〈 0.01 ）. The proportion of CD4^＋CD25^highFOXP3^＋ Treg cells and CD4^＋ FOXP3^＋ T cells was negatively correlated with CD4^＋/CD8 ＋ ratio（ r = - 0.54, - 0.52, respectively; P 〈 0.01 ） and the proportion of NK cells （ r = - 0.41, - 0. 43, respectively; P 〈0. 05）, positively correlated with the level of LDH （ r = 0.51,0.57, respectively; P 〈 0.05 ）. Conclusion： The increased number of CD4^＋CD25^highFOXP3^＋Treg cells might be one of the important reasons of immunosuppression in AML. Analysis of its changes may be helpful on judgement of prognosis of AML. The function of CD4^＋ FOXP3^＋ Treg cells is similar to CD4^＋CD25^highFOXP3^＋ Treg cells. Measurement of its proportion may be more value on evaluation of therapeutic effect.