不同预后骨髓增生异常综合征患者T淋巴细胞亚群的分析

Analysis of T Lymphocyte Subsets in Patients with Myelodysplastic Syndrome under Different Prognostic Stratification

目的检测和分析不同预后的MDS患者T淋巴细胞亚群的变化,以评估不同阶段MDS患者免疫状态,有助于进一步评估疾病风险预后,从而深入探讨MDS的免疫调节机制。方法采用FC-500流式细胞仪对笔者医院2017年9月~2018年11月55例MDS患者和30例正常对照组外周血标本进行T淋巴细胞亚群检测。结果根据IPSS-R系统以及骨髓原始细胞比例将55例MDS患者分组分析发现,就Treg细胞而言,IPSS-R分组中,高危组以及极高危组分别与中危组、低危组以及对照组比较,差异均有统计学意义(P<0.05)。而NK细胞比例则相反,随着MDS患者IPSS-R预后评分的升高,各组间自然杀伤细胞比例逐渐降低,但差异无统计学意义(P>0.05);原始细胞比例≥5%组与原始细胞比例<5%组比较,Treg细胞比例明显升高,差异有统计学意义(P<0.05)。而两组间NK细胞比例比较差异无统计学意义,尽管在数值上,NK细胞表达水平仍呈现出下降趋势。结论MDS患者预后危险评分越高,从数值上看,Treg细胞比例越高,NK细胞比例降低。Treg细胞的升高以及NK细胞的减少可能与MDS的预后不良相关。

Objective To detect and analysis the changes of T lymphocyte subsets in MDS patients with different prognosis risk levels to evaluate the immune status of MDS patients at different stages is more helpful to further evaluate the disease risk prognosis and further explore the immune regulation mechanism of MDS.Methods FC-500 flow cytometry was used to detect T lymphocyte subsets in peripheral blood samples of 55 MDS patients and 30 normal controls in our hospital from September 2017 to November 2018.Results According to IPSS-R system and the proportion of bone marrow blast cells,55 MDS patients were grouped and analyzed again.For Treg cells,there were statistical differences for IPSS-R high risk group vs low risk or intermediate risk or control group,and very high risk group vs low risk or intermediate risk or control group(P<0.05).However,the proportion of NK cells was reversed.With the increase of IPSS-R prognosis score in MDS patients,the proportion of natural killer cells among each group was gradually decreased,but the difference was not statistically significant.Compared with the group of the myeloblast counts≥5%,the ratio of Treg cells in the group of myeloblast counts<5%was significantly increased(P<0.05),which was statistically significant.However,there was no significant difference in NK cell ratio between the two groups,although the expression level of NK cells still showed a downward trend numerically.Conclusion Numerically,the higher the prognosis risk score of MDS patients,the higher the proportion of Treg cells and the lower the proportion of NK cells.The increase of Treg cells and the decrease of NK cells may be associated with poor prognosis of MDS.