外周血T淋巴细胞亚群检测在再生障碍性贫血患者中的作用以及临床意义

The role and clinical significance of peripheral blood T lymphocyte subsets in patients with aplastic anemia

目的探究再生障碍性贫血(AA)患者外周血中T淋巴细胞亚群水平及意义。方法选取2017年1月—2020年4月于安徽省淮北市人民医院(以下简称“我院”)治疗的70例初诊AA患者作为观察组,其中30例为重型AA(SAA组),40例为非重型AA患者(非SAA组),同时我院选取40名健康体检者作为对照组。观察组接受治疗后45例缓解(缓解组,包括明显进步,缓解和基本治愈),25例未缓解(未缓解组)。流式细胞仪检测自然杀伤(NK)细胞、调节性T(Treg)细胞、CD4^(+)、CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)、Treg^(+)/CD4^(+)细胞水平。结果观察组NK细胞、Treg细胞、CD4^(+)、CD4^(+)/CD8^(+)、Treg^(+)/CD4^(+)均低于对照组,CD3^(+)、CD8^(+)均高于对照组(P<0.01)。SAA组Treg细胞、CD4^(+)、CD4^(+)/CD8^(+)、Treg^(+)/CD4^(+)均低于非SAA组(P<0.05)。未缓解组Treg细胞、CD4^(+)/CD8^(+)低于缓解组(P<0.05)。在AA患者中,Treg细胞以及CD4^(+)/CD8^(+)预测AA病情缓解的曲线下面积分别为0.71、0.75,两者联合预测的曲线下面积为0.82,特异性为67.5%,灵敏度为85.1%。结论AA患者存在T细胞亚群分布异常,且Treg联合CD4^(+)/CD8^(+)可评估病情和治疗效果。

Objective To explore the level of T lymphocyte subsets in peripheral blood of patients with aplastic anemia(AA)and its clinical significance.Methods A total of 70 AA patients treated at Huaibei People’s Hospital from January 2017 to April 2020 were selected as the observation group,of which 30 patients were severe AA(severe AA group)and 40 patients were non-severe AA(non-severe AA group),and 40 healthy people were selected as the control group.After receiving treatment in the observation group,45 cases were relieved(remission group),(including significant improvement,remission and basic cure),and 25 cases were not remission(non-remission group).The levels of natural killer(NK)cells,regulatory T(Treg)cells,CD4^(+),CD3^(+),CD8^(+),CD4^(+)/CD8^(+),and Treg^(+)/CD4^(+)were detected by flow cytometry.Results In the observation group,the celluar levels of NK,Treg,CD4^(+),CD4^(+)/CD8^(+),and Treg^(+)/CD4^(+)were all lower than those in the control group,and CD3^(+)and CD8^(+)were higher than those in the control group(P<0.01).The celluar level of Treg,CD4^(+),CD4^(+)/CD8^(+),and Treg^(+)/CD4^(+)in the severe AA group were lower than those in the non-severe AA group(P<0.05).The Treg cells and CD4^(+)/CD8^(+)in the non-remission group were lower than those in the remission group(P<0.05).In patients with AA,the areas under the curve of Treg cells and CD4^(+)/CD8^(+)predicting AA disease remission were 0.71 and 0.75,the area under the curve for the combination of the two was 0.82,the specificity was 67.5%,and the sensitivity was 85.1%.Conclusion Patients with AA have abnormal distribution of T cell subsets.Treg combined with CD4^(+)/CD8^(+)have certain value in assessing the condition and treatment effect.