AA、MDS和AML患者CD4^+T细胞亚群的变化及其临床意义

Changes and clinical significances of CD4^+T cell subsets in aplastic anemia, myelodysplastic syndromes and acute myeloid leukemia patients

目的探讨CD4+T细胞亚群(Th1、Th2、Th17及Treg细胞)在再生障碍性贫血(AA)、骨髓增生异常综合征(MDS)、急性髓系白血病(AML)患者免疫发病机制中的作用,为临床治疗提供实验依据。方法采用流式细胞术检测AA组25例,MDS组48例[其中难治性贫血(MDS-RA)22例,难治性贫血伴原始细胞增多(MDS-RAEB)26例],AML组12例和正常对照组8例的外周血单个核细胞Th1、Th2、Th17及Treg细胞比例并对比分析,评价各组的细胞免疫状态。结果与正常对照组相比,AA组Th1、Th17细胞及Th1/Th2升高,而Th2和Treg细胞比例减低(P<0.05);MDS组Th1、Th2细胞、Th1/Th2与正常对照组比较差异均无统计学意义(P>0.05),而Th17和Treg细胞比例升高(P<0.05);MDS-RA组Th1、Th17细胞比例和Th1/Th2均升高(P<0.05),Th2细胞比例减低(P<0.05),而Treg细胞比例差异无统计学意义(P>0.05);MDS-RAEB组和AML组Th1、Th17细胞比例和Th1/Th2减低(P<0.05),Th2和Treg细胞比例升高(P<0.05)。结论 AA、MDS不同阶段与AML患者的细胞免疫状态不同,在AA和MDS早期阶段,免疫因素介导的凋亡过度是骨髓衰竭的主要原因;而在MDS晚期和AML阶段,异常克隆细胞的大量积聚可能是其主要原因。

Objective To investigate the role of CD4＋T cell subsets in the immune pathogenesis of aplastic anemia（AA）,myelodysplastic syndromes（MDS）,and acute myeloid leukemia（AML）.Methods Flow cytometry was used to detect the proportion of T helper and Treg cells in peripheral blood mononuclear cells of 48 MDS,25 AA,12 AML patients and 8 normal controls.Results Compared with the control group,the percentages of Th1 and Th17 cells and Th1/Th2 were higher,but the percentages of Th2 and Treg cells were lower in the AA group（P0.05）.There was no significant difference in the percentages of Th1,Th2,Treg cells and Th1/Th2 between the MDS group and the control group（P0.05）,but the percentages of Th17 and Treg cells were higher in the MDS group（P0.05）.The percentages of Th1,Th17 cells and Th1/Th2 were higher and the percentage of Th2 cells was lower in the MDS-RA group,but there was no difference in the percentage of Treg cells between the MDS-RA group and the control group（P0.05）.In the AML and MDS-RAEB groups,the percentages of Th1 and Th17 cells and Th1/Th2 were significantly lower and the percentages of Th2 and Treg cells were higher than the normal controls（P0.05）.Conclusions Immune status is different in AA,variant MDS stages and AML.Immune-mediated excessive apoptosis could induce bone marrow failure in AA and the early stage of MDS.The large accumulation of abnormal clones could induce bone marrow failure in AML and late stage of MDS.