慢性髓系白血病患者外周血T淋巴细胞亚群和NK细胞检测的临床意义

Clinical Significance of Measurement of T Lymphocyte Subsets and Natural Kill Cell in Peripheral Blood of Patients with Chronic Myeloid Leukemia

目的研究不同分期慢性髓系白血病患者外周血T淋巴细胞亚群、NK细胞的变化特点,以及应用伊马替尼治疗后获得完全细胞遗传学反应(complete cytogenetic reponse,CCyR)患者淋巴细胞亚群表达情况。方法选取我院诊治40例慢性髓系白血病患者,其中急变期9例,慢性期31例。采用流式细胞术检测外周血T淋巴细胞亚群、NK细胞水平,并与正常对照组进行比较。结果初治慢性期、急变期CML患者外周血CD3^+、CD4^+、CD8^+T细胞百分率及CD4^+/CD8^+比值均低于正常对照组,且急变期CD3^+、CD4^+T细胞百分率及CD4^+/CD8^+比值下降尤为突出(P<0.01);初治慢性期患者NK细胞百分率与正常对照组相比无差异,而急变期患者低于正常对照组(P<0.05)。与正常组对比,伊马替尼治疗首次获得完全细胞遗传学反应患者仅CD4^+T细胞百分率降低,差异具有统计学意义(P<0.05);但获得完全细胞遗传学反应后应用伊马替尼治疗大于12月患者,CD3^+、CD4^+T细胞百分率及CD4^+/CD8^+比值较正常对照组均有所下降(P<0.05)。与治疗前相比,治疗首次获得完全细胞遗传学反应患者CD3^+、CD4^+T细胞百分率升高(P<0.05),而缓解后应用伊马替尼治疗大于12月患者T淋巴细胞亚群无改变(P>0.05);各组的NK细胞百分比无差异(P>0.05)。初诊CML患者、急变期CD4^+/CD8^+的比值与BCR-ABL1/ABL1的比值呈负相关。结论 CML患者存在细胞免疫调节功能异常,且机体免疫功能与疾病分期密切相关。伊马替尼治疗初次获得完全细胞遗传学反应患者细胞免疫功能得到改善,但长期应用抑制患者细胞免疫功能。

Objective To determine the T lymphocyte subsets and NK cells in peripheral blood of patients with clinical different times and complete cytogenetic reponse（ CCyR） after imatinib（ IM） therapy in chronic myeloid leukemia（ CM L）. Methods The percentages of T lymphocyte subsets and NK cells were determined by flowcytometry in peripheral blood of forty patients with CM L including 31 cases in chronic phase（ CP）and 9 cases in blastic phase（ BP）. 12 normal subjects were enrolled as control group. Results The percentages of CD3~＋,CD4~＋,CD8~＋T cells and CD4~＋/ CD8~＋in CM L of BP and CP patients were lower than those in healthy subjects. The levels of CD3~＋,CD4~＋,CD8~＋T cells and CD4~＋/ CD8~＋were depressed more significantly in BP of CM L as compared with healthy controls and CP patients（ P 〈0. 01）. The percentages of NK cells in BP of CM L were lower than those in healthy subjects and CP of CM L（ P 〈0. 05）. After imatinib therapy,patients with achieved CCyR had lower percentage of CD4~＋T cells than healthy controls（ P 〈0. 05）. The percentage of CD3~＋,CD4~＋,CD8~＋T cells and CD4~＋/ CD8~＋weredepressed in patients with IM therapy at 12 thor more month after CCyR compared with healthy controls（ P 〈0. 05）. At time of CCyR achievement,the percentages of CD3~＋,CD4~＋T cell were higher than donors of newly diagnosed CM L. There were no differences between CP of CM L and CCyR of CM L with IM therapy beyond 12 thor more months. There were no differences in NK percentages among three groups. CD4~＋/CD8~＋had negative correlation with BCR-ABL1 / ABL1 in CM L of BP and CP patients. Conclusion The cellular immune function of T lymphocyte is abnormal in patients with CM L,it is closely related to clinical stage. At time of CCyR achievement,T lymphocyte subsets were increased in patients compared with newly diagnosed CP of CM L,but IM had immunosuppressive effect on patients for prolonged treatment.