辅助性T细胞17在铁过载骨髓增生异常综合征中的临床意义

The clinical significance of Th17 cells in patients with myelodysplastic syndrome and iron overload

目的探讨辅助性T细胞17(Th17)在铁过载骨髓增生异常综合征(MDS)中的临床意义。方法收集2017年1月至2018年12月广州市第一人民医院的77例MDS患者资料。以血清铁蛋白>1 000 μg/L为界,分为铁过载组(37例)和非铁过载组(40例)。采集两组患者的外周血和骨髓制备单个核细胞,通过流式细胞术分选CD4+T细胞,比较两组患者的Th17细胞比例、异常核型及IL-6、IL-17的蛋白及mRNA表达水平的差异。结果(1)铁过载组Th17细胞占CD4+细胞的比例在外周血和骨髓中均高于非铁过载组[(41.06±0.96)%比(26.80±1.21)%;(47.39±1.60)%比(34.29±1.03)%;P值均<0.01]。(2)铁过载组外周血和骨髓中的Th17细胞的异常核型百分比均高于非铁过载组[(4.96±0.53)%比(3.67±0.12)%;(10.06±1.67)%比(4.36±0.43)%;P值均<0.01]。(3)铁过载组外周血和骨髓中IL-6、IL-17的蛋白及mRNA表达水平均高于非铁过载组(P值均<0.01)。结论IL-6和IL-17是Th17细胞分泌的代表性造血调控因子,铁过载MDS患者的外周血和骨髓中IL-6和IL-17的表达水平增高,可能对Th17细胞的核型及分化趋势有影响。

Objective To study the significance of Th17 cells in patients with myelodysplastic syndrome (MDS) and iron overload. Methods A total of 77 patients with MDS admitted to Guangzhou First People′s Hospital were enrolled from January 2017 to December 2018,who were divided into iron overload group (37 cases) with serum ferritin (SF) over 1000 μg/L and non-ferrous overload group(40 cases). CD4+T cells in peripheral blood (PB) and bone marrow (BM) were sorted by flow cytometry. The ratio of Th17 cells and cells with abnormal karyotype were compared. IL-17 and IL-6 protein and RNA expression were detected by ELISA and quantitative real-time PCR(qRT-PCR). Results The proportions of Th17 cells in PB and BM in iron overload group were significantly higher than those in non-iron overload group [(41.06±0.96)% vs.(26.80±1.21)%;(47.39±1.60)% vs.(34.29±1.03)%;P<0.01]. The Th17 positive cells with abnormal karyotype in iron overload group were more than those in non-iron overload group[(4.96±0.53)% vs.(3.67±0.12)% in PB;(10.06±1.67)% vs.(4.36±0.43)% in BM;P<0.01]. Similarly,the protein levels as well as mRNA expression of IL-6 and IL-17 in patients with iron overload were significantly higher than those in non-iron overload group (P<0.01 both in PB and BM). Conclusions As hematopoietic regulators secreted by Th17 cells, the expression of IL-6 and IL-17 in MDS patients with iron overload are elevated. This may predict the influence of these factors to the differentiation of Th17 cells.