Tfh/Tfr细胞失衡在B细胞淋巴瘤患者中的临床意义

Clinical Significance of Tfh/Tfr Cell Imbalance in Patients with B-Cell Lymphoma

目的:探讨滤泡辅助性T细胞(Tfh)/滤泡调节性T细胞(Tfr)失衡在B细胞淋巴瘤(BCL)中的作用。方法:收集宜昌市第一人民医院血液科2019年12月至2020年11月确诊的16例BCL患者作为观察组,20例健康人作为对照组,采用流式细胞术检测外周血Tfh、Tfr细胞水平,比较两组Tfh、Tfr细胞水平及Tfh/Tfr比值的变化情况,同时比较化疗及多种临床因素下患者Tfh、Tfr细胞水平及Tfh/Tfr比值的变化情况,分析Tfh/Tfr比值与疗效及预后的关系。结果:与健康对照组比较,BCL患者外周血Tfh细胞水平、Tfh/Tfr比值明显升高(P<0.05,P<0.01),而Tfr细胞水平明显降低(P<0.01)。与化疗前比较,BCL患者化疗后外周血Tfh细胞水平、Tfh/Tfr比值均明显降低(P<0.01),而Tfr细胞水平化疗前后无差异。多因素分析结果显示,BCL患者Tfh细胞水平、Tfh/Tfr比值与IPI评分、Ann Arbor分期呈正相关(r=0.626,0.564,0.573,0.608),Tfr细胞水平与IPI评分、Ann Arbor分期呈负相关(r=-0.504,-0.542)。根据初诊时Tfh/Tfr平均值将BCL患者分为Tfh/Tfr高比值组与低比值组,发现高比值组的完全缓解率、总有效率及生存时间均明显低于低比值组(P<0.01)。结论:BCL患者外周血存在Tfh/Tfr比例失衡,高比值者的完全缓解率及总有效率更低,生存期更短。

Objective:To explore the role of follicular helper T cell(Tfh)/follicular regulatory T cell(Tfr)imbalance in B-cell lymphoma(BCL).Methods:Sixteen BCL patients who were admitted to the Department of Hematology of The First People’s Hospital of Yichang and 20 healthy people from December 2019 to November 2020 were enrolled and respectively divided into observation group and control group.The levels of Tfh and Tfr in peripheral blood were detected by flow cytometry.The changes of Tfh,Tfr,and Tfh/Tfr ratio were compared and the relationship between Tfh/Tfr ratio and efficacy,prognosis was analyzed.Results:Compared with the healthy controls,Tfh and Tfh/Tfr ratio in peripheral blood of the BCL patients increased(P<0.05,P<0.01),while levels of Tfr was decreased(P<0.01).After chemotherapy,Tfh and Tfh/Tfr ratio in peripheral blood of the BCL patients decreased significantly than before chemotherapy(P<0.01),but Tfr was no significant difference.M ultivariate analysis showed that Tfh and Tfh/Tfr ratio were positively correlated with international prognostic index(IPI)score and Ann Arbor stage(r=0.626,0.564,0.573,0.608,respectively),while Tfr negatively(r=-0.504,-0.542,respectively).According to the average value of Tfh/Tfr ratio at initial diagnosis,BCL patients were divided into Tfh/Tfr high ratio group and low ratio group.It was found that the complete remission(CR)rate,overall response rate(ORR),and survival time in the high ratio group were significantly lower than the low ratio group(P<0.01).Conclusion:There is an imbalance of Tfh/Tfr ratio in peripheral blood of the BCL patients,and those with a high Tfh/Tfr ratio have lower CR,ORR and shorter survival time.