T淋巴细胞亚群失衡与全身型重症肌无力临床症状加重及缓解的相关性研究

Correlation between imbalance of T lymphocyte subsets and symptom fluctuation in patients with myasthenia gravis

目的:观察全身型重症肌无力(myasthenia gravis, MG)患者血中T淋巴细胞亚群百分比的变化,分析其与患者症状加重或缓解间的关系。方法:采用流式细胞术分别检测51例全身型MG患者在病情加重及缓解的不同时期外周血中T淋巴细胞亚群百分比的变化,分析其与症状波动之间的关系,另设30名健康体检者为对照组。结果:加重期MG患者血中的CD4+CD25+CD127low/-调节性T淋巴细胞和CD4+CD45RA+原始T淋巴细胞百分比均明显低于对照组(5.54%±1.88%比7.95%±3.45%,P<0.05;11.42%±6.97%比24.98%±7.86%,P<0.05);而MG患者加重期血中的CD4^+CD45RO^+T淋巴细胞百分比高于缓解期及对照组(35.06%±8.78%比30.82%±8.43%;35.06%±8.78%比30.09%±7.53%,P均<0.05)。采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析淋巴细胞百分比在MG诊断中的价值,患者血中的CD4^+CD25^+CD127^(low/-)调节性T淋巴细胞和CD4+CD45RA+T淋巴细胞诊断全身型MG发病的ROC曲线下面积(area under curve,AUC)分别为0.713和0.900(P<0.05);CD4^+CD45RO^+T淋巴细胞诊断MG症状加重的AUC为0.675,其最佳临界值为32.06%。结论:检测调节性T淋巴细胞和CD4^+CD45RA^+T淋巴细胞百分比对全身型MG的发病具有一定诊断价值,而CD4^+CD45RO^+T淋巴细胞百分比与全身型MG患者的症状波动相关,有可能成为衡量其病情变化的标志物。

Objective: To investigate the relationship between changes of T lymphocytes and exacerbation and remission in patients with generalized myasthenia gravis(GMG). Methods: Flow cytometry was used to detect the change of T lymphocyte subsets in peripheral blood of 51 patients with GMG during different periods of exacerbation and remission,and analyzed the relationship between the changes of T lymphocytes and symptom fluctuations. Results: The percentage of CD4^+CD25^+CD127 low/-regulatory T lymphocytes and CD4^+CD45 RA^+naive T lymphocytes was significantly lower in exacerbation period than that in control group(P<0.05), whereas the percentage of CD4^+CD45 RO^+memory T lymphocytes in exacerbation period was significantly higher than that in remission period and control group(P <0.05). The AUC of CD4^+CD25^+CD127^low/- regulatory T lymphocytes and CD4^+CD45 RA^+naive T lymphocytes were 0.713 and 0.900, respectively. The AUC of CD4^+CD45 RO^+memory T lymphocytes in exacerbation period was 0.675 and the optimum critical value was32.06%. Conclusions: Regulatory T lymphocytes and CD4^+CD45 RA^+naive T lymphocytes have diagnostic value for GMG.CD4^+CD45 RO^+memory T lymphocytes are correlated with symptom aggravation and remission of GMG, and may be used as a marker for measuring the symptom fluctuation of myasthenia gravis.