沙利度胺对急性白血病患者外周血调节性T细胞的影响及其临床疗效评价

Effect of thalidomide on peripheral blood regulatory T cells and evaluation of its clinical effect in patients with acute myelocytic leukemia

目的评定沙利度胺（thalidomide）对急性髓细胞白血病（acute myelocytic leukemia,AML）患者CD4＋CD25＋T淋巴细胞的影响及其临床疗效。方法将71例AML患者随机分为常规化疗方案对照组（37例）和沙利度胺加常规化疗方案治疗组（34例）,另有31例健康者纳入正常组。治疗组和对照组患者均接受相同化疗方案,其中治疗组加用沙利度胺。分别检测治疗前、第二疗程化疗结束后10~14d、完全缓解后随访6个月或随访过程中复发时血清CD4＋CD25＋T淋巴细胞、CD3＋T淋巴细胞、CD4＋T淋巴细胞、CD8＋T淋巴细胞、CD4＋/CD8＋比值、NK细胞水平,正常组于对应化疗前及化疗结束后10~14d检测相同指标。观察治疗组和对照组患者临床疗效。结果治疗组有效缓解率较对照组高（P〈0.05）;治疗组和对照组患者治疗前CD4＋CD25＋T淋巴细胞水平均明显高于正常组（P〈0.05）,治疗后2组均下降（P〈0.05）;与对照组相比,治疗组CD4＋CD25＋T淋巴细胞水平明显降低（P〈0.05）。加用沙利度胺治疗后,治疗组在CD3＋T淋巴细胞、CD4＋T淋巴细胞、CD4＋/CD8＋比值、NK细胞水平均明显高于对照组（P〈0.05）。结论沙利度胺可改善AML患者细胞免疫功能和提高临床缓解有效率,机制与下调CD4＋CD25＋T淋巴细胞水平相关。

Objective To evaluate of impact of thalidomide on CD4＋CD25＋T lymphocytes in patients with acute myeloid leukemia and its clinical curative effect. Methods 71 cases of patients with AML were randomly divided into the control group and the experiment group,and 31 healthy people were selected to be the normal group. The experiment group and the control group patients were treated with the same chemotherapy,the experiment group was treated with thalidomide. The levels of CD4＋CD25＋T lymphocyte,CD3＋T lymphocyte,CD4＋T lymphocyte,CD8＋T lymphocyte,ratio of CD4＋/ CD8＋and NK cells were detected at before treatment,10 to 14 d after treatment,complete remission 6 months follow-up. In normal group,the same index was detected before and after chemotherapy,and 10-14 d. The clinical curative effect of the experiment group and the control group were observed. Results The effective rate of the experiment group was higher than of the control group（ P〈0. 05）; The levels of CD4＋CD25＋T lymphocyte in the experiment group and control group were significantly higher than in the normal group（ P〈0. 05）,the two groups decreased compared with the control group,the level of CD4＋CD25＋T lymphocyte in the experiment group was significantly decreased（ P〈0. 05）. And with thalidomide treatment,the experiment group in the CD3＋T lymphocytes,CD4＋T lymphocytes and ratio of CD4＋/ CD8＋,NK cells were significantly higher than the control group（ P〈0. 05）. Conclusion Thalidomide can improve both the immunity cell function and the clinical efficiency in patients with AML. The mechanism is related to reduce the level of CD4＋CD25＋T lymphocyte.