外周血免疫细胞亚群的变化与B细胞淋巴瘤患者的预后关系研究

Relationship of the Changes of Peripheral Blood Immuno-Cell Subsets with the Prognosis of B Cell Lymphoma Patients

目的:探讨T淋巴细胞亚群、B淋巴细胞和NK细胞与B细胞淋巴瘤(B-cell lymphoma,BCL)发生、发展及预后的关系。方法:采用流式细胞技术(FCM)检测健康对照组及BCL患者疾病不同时期外周血T淋巴细胞亚群、B淋巴细胞及NK细胞的水平;收集患者临床资料,分析这些免疫指标与患者一般状况、实验室检查指标、疗效及预后的关系。结果:本组患者共44例,男∶女=24∶20,中位年龄57(17-82)岁,所有患者均为初次就诊。患者外周血总淋巴细胞、总T细胞、总B细胞、NK细胞计数显著低于健康对照组,晚期活化T细胞比例显著高于健康对照组,2组间差异有统计学意义(P <0. 05)。达到完全缓解(CR)的患者的外周血总淋巴细胞、总T细胞、总B细胞、CD4+细胞、NK细胞数目显著高于未达到完全缓解即部分缓解(PR)及疾病进展(SD)的患者(P <0. 01,P <0.01,P <0. 05,P <0. 01,P <0. 05)。应用Logistic回归分析方法进一步探讨ECOG评分、LDH、β2微球蛋白水平、结外累及部位数目、有无B症状、CD4+细胞、NK细胞、FAC-1(FAC-1是对总淋巴细胞、总T细胞、总B细胞进行线性回归后得出的成分因子)发现,NK细胞、FAC-1、ECOG评分、β2微球蛋白水平在CR组和PR+SD组水平有显著差异(P <0. 05,P <0. 01,P <0. 05,P <0. 01),其中ECOG评分、β2微球蛋白水平为影响患者预后的独立危险因素,NK细胞和FAC-1为预后保护因素。根据初诊时患者NK细胞水平对患者作生存分析,应用Kaplan-Meier方法绘制生存曲线发现,NK细胞绝对计数> 61. 5/μl者的总生存期(OS)明显高于NK细胞水平低者(P <0. 000)。结论:BCL患者总淋巴细胞、总T细胞、总B细胞、NK细胞、晚期活化T细胞水平与正常人群存在显著差异;外周血总淋巴细胞、总T细胞、总B细胞、CD4+细胞、NK细胞计数是判断BCL预后的重要参考指标; ECOG评分、β2微球蛋白为影响患者预后的独立危险因素; NK细胞、FAC-1为判断BCL预后的独立保护因素。

Objective To investigate the relationship of T lymphocyte subsets,B lymphocytes and NK cells with the genesis, progression and prognosis of B cell lymphoma.Methods: The levels of T lymphocyte subsets,B lymphocytes and NK cells in peripheral blood of healthy control group and B cell lymphoma group were detected by flow cytometry ( FCM) .The clinical data were collected,and the relationship of these immune indexes with the general conditions,laboratory indexes,curative effect and prognosis were analyzed.Results: Forty - four patients entolled in this study including 24 male and 20 females with the median age of 57 years old ( 17 - 82 years) ,all the patients were the first visit to our hospital and diagnosed.The total counts of lymphocytes,T,B and NK cells in the peripheral blood of patients with the first treatment of B-cell lymphoma were significantly lower than those in healthy controls,and the ratio of CD3 + HLA-DR + activated T cells was significantly higher than that of healthy controls ( P<0.05) .In the newly diagnosed patients,the levels of total lymphocytes,total T cells,total B cells,CD4 + cells and NK cells in peripheral blood of patients with complete remission ( CR) were higher than those in patients without complete remission [partial remission ( PR) and disease progression( PD) ]( P<0.01,P<0.01,P<0.05,P<0.01,P<0.05,respectively) .The logistic regression analysis showed that NK cells,FAC-1( FAC-1 is a component factor for linear regression of total lymphocytes,total T cells,and total B cells) ,the ECOG score and β2-microglobulin level were significantly different between CR group and PR + SD group ( P<0.05,P<0.01,P<0.05,P<0.01,respectively) ,among which ECOG score and β2-microglobulin were independent risk factor respectively for the prognosis of patients.The NK cells and FAC-1 were the protective factors for the prognosis of patients.The survival analysis performed according to the NK cell level of patients at initial diagnosis,the Kaplan - Meier survival curve found that the overall survival ( OS) of the 2 groups was significantly different ( P<0.01) ,the survial rate in patients with NK cell absolute count >61.5 /μl was higher than that in patients with low level of NK cells.Conclusion: The level of total lymphocytes,total T cells,total B cells,NK cells and advanced activated T cells in the patients with B cell lymphoma were significantly different from those in normal subjects.Total count of lymphocytes,T cells,B cells,CD4 + cells and NK cells in peripheral blood are important prognostic indicators for BCL.The ECOG score and β2 microglobulin level are independent risk factors for prognosis.The NK cell level and FAC-1 are independent protective factors for the prognosis of B cell lymphoma.