髓性白血病骨髓单个核细胞表面CD_(40)、CD_(40)L的表达及其意义

Expression of CD_(40), CD_(40)L on mononuclear cells surface of myeloid leukemia and its clinical significance

目的研究共刺激分子CD40、CD40L在人急、慢性髓性白血病治疗前后骨髓单个核细胞表面的表达特点,探讨其与临床疗效的关系。方法应用免疫荧光标记及流式细胞术(FACS)检测了37例急性髓性白血病及20例慢性髓性白血病患者治疗前后骨髓单个核细胞表面共刺激分子CD40、CD40L的表达。另取8例健康人骨髓作为正常对照组。结果①治疗前急性髓性白血病(AML)患者中,除急性早幼粒细胞白血病(M3)外,CD40表达均低于正常对照组(P<0.05);②治疗后完全缓解(CR)和部分缓解(PR)患者CD40较其治疗前显著增高(P<0.05),CR患者接近对照者,而未缓解(NR)患者CD40的表达差异无统计学意义(P>0.05);③CD40在慢性粒细胞白血病骨髓单个核细胞上的表达与正常对照差异无统计学意义(P>0.05);④所有急、慢性髓性白血病患者及正常对照骨髓单个核细胞上的CD40L均存在表达缺陷,差异无统计学意义(P>0.05)。结论 CD40是参与急性髓性白血病(AML)发病和抗白血病免疫反应的重要共刺激分子,其表达与白血病分化程度及分型有关,CD40表达异常可能是AML发病机制之一,且与临床疗效密切相关;调节单个核细胞上CD40的表达,纠正AML白血病患者细胞免疫功能缺陷,可能是免疫基因治疗人类急性髓性白血病的重要手段之一,具有一定的临床应用价值。

Objective To study the expression characteristics ofcostimulatory molecules CD40 and CD40L in bone marrow mononuclear cells in human acute and chronic myeloid leukemia before and after the chemotherapy, and to explore their significance in antileukemia immunity. Methods The expression of costimulatory molecules CD40 and CD40L in bone marrow mononuclear cells was measured in 37 patients with acute myeloid leukemia （AML group） and 20 patients with chronic myeloid leukemia （CML group） before and after chemotherapy by immunofluorescence and FACS. The results were compared with eight cases of healthy bone marrow （the control group）. Results （1） The level of CD40 in AML group except for M3 before chemotherapy was significantly lower than those in the control group （P〈0.05）. （2） The level of CD40 increased in complete remission （CR） and partial remission （PR） patients after chemotherapy compared with that before chemotherapy （P〈0.05）. The level in CR patients was close to that in the control. No significant change was found in nonremission （NR） patients （P〉0.05）. （3） The level of CD40 in CML patients was close to that in the con- trol, No significant change was found in CML patients （P〉0.05）. （4） Moreover, the CD40L are deficient in BMMC of all cases, including AML, CML and healthy volunteers （P〉0.05）. Conclusion CD40 are important costimulatory mol- ecules during the pathogenesis and antileukemia immunity of AML. The level of CD,o may be related to differentiated degree and classification of myeloid leukema. Their abnormal level may partly be responsible for the pathogenesis of AML and be closely related with the clinical curative effects. It may be one of important means to treat human acute myeloid leukemia immunogenetically by regulating the expression of CD40 in mononuclear cells and by correcting the immunodeficiency of AML patients.