外周血单个核细胞功能检测对急性再生障碍性贫血患者的临床意义

Clinical significance of peripheral blood mononuclear cell function in patients with acute aplastic anemia

目的观察急性再生障碍性贫血(AAA)患者外周血单个核细胞(PBMNC)功能在治疗前及治疗后的变化,明确其临床意义。方法纳入初发AAA患者26例为实验组,给予联合免疫抑制治疗。另取10例健康捐献者外周血标本作为对照组。采集AAA患者治疗前及治疗后3个月、6个月时外周血标本,分离提取PBMNC。观察两组患者肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)、白细胞介素3(IL-3)水平及PBMNC对健康人骨髓粒-巨噬细胞集落形成单位的抑制作用。结果联合免疫抑制治疗的总有效率为69.2%(18/26)。对照组、实验组治疗前、治疗后3个月、6个月的TNF-α表达分别为(59±4)、(160±5)、(84±4)及(68±3)ng/L,IFN-γ分别为(23.1±2.4)、(126.4±11.6)、(62.5±4.3)及(31.6±3.3)ng/L,IL-3分别为(33.1±2.8)、(11.2±1.0)、(20.9±1.6)及(31.1±1.7)ng/L。与对照组比较,治疗前及治疗后3个月,实验组患者PBMNC分泌TNF-α及IFN-γ显著升高,IL-3表达显著降低,且治疗6个月后上述各指标显著优于治疗前及治疗后3个月(F=213.760、146.382、34.329,P均<0.05)。此外,患者治疗前、治疗后3个月及6个月免疫活性淋巴细胞对造血祖细胞的抑制率分别为(57±10)、(26±8)及(18±11)%,治疗后6个月的抑制率明显低于治疗前及治疗后3个月(F=74.729,P<0.001)。结论PBMNC分泌的IL-3、TNF-α及IFN-γ水平对评判AAA病情变化有指导作用。

Objective To observe the clinical significance of peripheral blood mononuclear cell（PBMNC） in patients with acute aplastic anemia（AAA）. Methods A total of 26 patients with newly diagnosed acute aplastic anemia were enrolled in this study（AAA group）, and treated with combined immunosuppressive therapy, while 10 peripheral blood samples of healthy donors as the control group. Peripheral blood samples in the AAA group were collected when diagnosed and on 3 and 6 months after the treatment, and the PBMNC were separated. The level of tumor necrosis factor-alpha（TNF-α）, interferon-γ（IFN-γ） and interleukin-3（IL-3） were tested in the two groups and the inhibition ability of PBMNC on normal human bone marrow colony forming units-granulocyte / macrophage（CFU-GM） were observed as well. Results The overall effective of combined IST is 69.2%（18 / 26）. The levels of TNF-α were（59 ± 4）,（160 ± 5）,（84 ±4） and（68 ± 3） ng / L, IFN-γ levels were（23.1 ± 2.4）,（126.4 ± 11.6）,（62.5 ± 4.3） and（31.6 ±3.3） ng / L, the levels of IL-3 were（33.1 ± 2.8）,（11.2 ± 1.0）,（20.9 ± 1.6） and（31.1 ± 1.7） ng / L in controls, before and on 3 months, 6 months after the treatment. The levels of TNF-α and IFN-γ in PBMNC from the AAA group before and on 3 months after the treatment were much higher, and IL-3 were much lower than those in the control group, and the above indicators in the AAA group on 6 months after the treatment were much better than those before and on 3months after the treatment（F = 213.760, 146.382, 34.329, all P〈0.05）. In the AAA group, the inhibition rates of immunocompetent lymphocytes in CFU-GM were（57 ± 10）,（26 ± 8） and（18 ±11）% before and on 3 months, 6 months after the treatmenton. The inhibition rates on 6months after the treatment were obviously lower than those before and on 3 months after the treatment（F = 74.729, P〈0.001）. Conclusion The levels of TNF-α, IFN-γ and IL-3 in PBMNC may be related to the pathogenesis of AAA and can indicate the change and prognosis of the disease in some way.