T淋巴细胞亚群结合遗传学检测在初发急性白血病中的相关研究

Analysis the T Lymphocyte Subsets and the Changes in Cytogenetics of Peripheral Blood with the Primary Patient Suffered from Acute Leukemia

目的通过检测急性白血病（Acute Leukemia，AL）患者外周血中T细胞亚群来了解初发患者的免疫功能，同时结合细胞遗传学的变化进一步探讨白血病发生、发展及转归与细胞免疫的关系。方法采用多参数流式细胞术分析172例初发急性白血病患者T细胞亚群，以CD4／CD8〈1为比例倒置；常规染色体核型结合荧光原住杂交（fluorescence in situ hybridization，FISH）检测分析有无核型异常。结果所有患者中共有118例（68．6％）出现CD4／CD8比例倒置，CD4／CD8平均表达率在患者组为0．99±0．6，在对照组为1．9±0．5，两者差异有明显统计学意义（P=0．005）；根据遗传学特征将急非淋（ANLL）和急淋（ALL）分成3组：预后良好组、预后中等组、预后较差组，CD4／CD8在预后良好组和预后中等组差异无明显统计学意义（P=0．629），预后良好组扣预后较差组，以及预后中等组和预后较差组差异均有明显统计学意义（P=0．000，P=0．005）；CD4／CD8比值在不同年龄组差异无明显统计学意义（P=0．591）。结论CD4／CD8比例倒置直接导致免疫功能的紊乱，影响机体的肿瘤免疫效应。细胞遗传学检查被认为是AL重要的预后相关指标，伴染色体核型高度异质性的患者免疫监视功能更为低下，该类患者肿瘤细胞更易逃脱免疫监视而加速肿瘤的发生与发展，如能充分了解患者淋巴细胞亚群和功能，以进一步了解患者免疫状态，对临床个体化治疗有积极地指导作用。

Objective To understand the immune function of the primary patient suffered from acute leukemia（AL）,by detecteing the T lymphocyte subsets in peripheral blood of them and together with the changes in cytogenetics,to futher investigateur the further relationship between cellular immunity and the genesis ,development,turnover of the acute leukemia. Methods Analysed the T lymphocyte subsets in 172 primary patients suffered from acute leukemia by the muhiparameter flow cytometry,with CD4/CD8〈1 as rate inversion and detected the abnormal karyotype that was proceeded by normal chromosome karyotype analysis and fluorescence in situ hybridization（FISH）. Results Among the whole patients ,118 patients （68.6%） occurred CD4/CD8 inversion,and on average the expression rate of CD4/CD8 was 0. 99±0. 6 in sufferer group with 1.9±0. 5 in control group. There was statistical significance between the them（P=0. 05）. According to the difference in Genetics and the prognosis,divided the patients with ANLL or ALL into 3 groups ：better,medium,worse. It had demonstrated that there was no statistical significance about the rate of CD4/CD8 between the better and medium groups （P=0. 629）,but there was statistical significance between the better and worse groups（P= 0. 0007 ,as between the medium and medium groups （P= 0. 005）. There was no statistical significance between the different ages （P = 0. 591）. Conclusion CD4/CD8 rate inversion directly disrupted the immune functlon,affected the immune surveillance which repressed the tumorgenesls. It was considered that eytogenetics analysis is a important marker of prognosis in AL patients. And found that immune surveillance in patients whose chromosome karyotype were highly heterogeneity were more hypofunetion,so these patients＇ turner ceils could easily escape the immune surveillanee,accelate the tumorgenesis. Thus,if understand the subsets of lymphocytes and their functions,and can further understand the immune state of the patient,it will give a guidance to the clinical personal treatment.