多发性骨髓瘤细胞免疫功能的研究

Celluar immunity changes and its clinical significance in multiple myeloma

目的探讨多发性骨髓瘤(MM)患者细胞免疫功能变化及其临床意义。方法采用流式细胞术检测天津医科大学总医院2008年1月至2009年12月住院诊疗的40例MM患者T细胞亚群、树突状细胞(DC)、效应性T细胞、辅助性T细胞(Th)及调节性T细胞数量变化,分析MM患者细胞免疫指标与血红蛋白(Hb)、β2微球蛋白(β2-MG)、白蛋白、血清肌酐及血清钙的相关性。结果与对照组相比,初诊组CD4+/CD8+、DC1/DC2、CD8+CD25+/CD3+T细胞的比值均降低;Th1/Th2比值显著降低(P<0.05);CD4+CD25+/CD3+T细胞的比值升高(P<0.01)。与初诊组相比,化疗后MM患者CD4+/CD8+、DC1/DC2及Th1/Th2比值显著升高(P<0.05)。CD8+CD25+/CD3+T的比值升高。与稳定期MM患者相比,进展期患者CD4+/CD8+、DC1/DC2、Th1/Th2及CD8+CD25+/CD3+T均降低,CD4+CD25+/CD3+T升高。CD4+/CD8+、DC1/DC2及Th1/Th2降低的MM患者,同时伴有β2-MG和肌酐升高(P<0.01),血红蛋白降低(P<0.01),白蛋白及血清钙降低。CD4+CD25+/CD3+T及CD4+CD25+CD127low/CD4+T升高的MM患者,伴有β2-MG和血清肌酐上升,血红蛋白和白蛋白降低。结论 MM患者T细胞亚群、DC、辅助性T细胞及效应性T细胞均有不同程度数量减少和功能下降,调节性T细胞相对数量增多,这些异常和MM病情及预后相关。

Objective To explore the cellular immunity changes and its clincial significance in multipe myeloma （MM）. Methods The numbers of T cell subsets, Dendritic cells （ DC ）, effective T cells, regulatory T cells and helper T cells（Th）in 40 cases of MM patients were examined by flow cytometry. The association of cellular immunity parameters of the MM patients with haemoglobin（Hb）, β2-microglobulin（β2-MG） ,serum albumin,serum creatinine and serum calcium were analyzed. Results Compared with normal control group, the ratios of T lymphocyte subgroup（ CD4^＋/CD8^＋）, DC1/DC2 and activated effector T cell（ CD8 ^＋ CD25^＋/CD3 ^＋） of newly diagnosed group were reduced; the ratio of helper T cell subgroup（ Th1/Th2 ） was significantly decreased （P 〈 0. 05 ） ; the ratio of CD4^＋ CD25^＋/CD3^＋ T cell was significantly higher（ P 〈 0. 01 ） in the newly diagnosed group. The ratios of CD4^＋/CD8^＋, DC1/DC2 and Th,/Th2 in the MM patients after chemotherapy were significantly higher than that of the newly diagnosed group （ P 〈 0. 05 ）, while there were no significant changes in the ratios of CD4^＋ CD25^＋/CD3^＋T cell and CD4^＋ CD25^＋ CD127^low/CD4^＋T cell between the two groups. Compared with the disease stable group, the ratios of CD4^＋/CD8^＋ , DC1/DC2, Th1/Th2 and CD8 ^＋ CD25 ^＋/CD3^＋ T cell of MM patients in the phase of disease progression were decreased and the ratios of CD4 ^＋ CD25 ~/CD3 ^＋ T was higher. （3） The MM patients who had lower ratios of CD4^＋/CD8^＋ , DC,/DC2 and Th1/Th2 had higher levels of β2-microglobulin （β2-MG） and serum creatinine （ P 〈 0. 05 ）, lower haemoglobin （Hb） （ P 〈 0. 01 ） and lower Serum albumin and serum calcium. The MM patients who had higher ratios of CD4^＋ CD25^＋/CD3 ^＋ T and CD4 ^＋ CD25 ^＋ CD127^low/ CD4^＋T had higher levels of β2-microglobulin （β2-MG） and serum creatinine and lower levels of haemoglobin （Hb） and serum albumin. Conclusion There are down-regulations of quantity and function of T cell subgroup, DC cell, helper T cell and effector T cell, while the regulatory T cells relatively rise. These abnormalities are relat- ed with the condition and prognosis of MM patients.