自身免疫性溶血性贫血患者免疫细胞与免疫球蛋白检测的临床意义

Clinical significance of detection of immune cells and immunoglobulins in patients with autoimmune hemolytic anemia

目的:探究自身免疫性溶血性贫血(AIHA)患者免疫细胞与免疫球蛋白检测的临床意义。方法:选取2014年6月—2019年10月收治的60例AIHA患者为观察组,另选取30例同期健康体检人群作为对照组。采用红细胞放散液进行免疫球蛋白IgG亚类检测,结合患者血细胞参数[白细胞(WBC)、红细胞(RBC)、血红蛋白(HGB)、血细胞比容(HCT)],比较2组患者IgG亚类含量及血细胞参数,经受试者工作曲线(ROC)评估各IgG亚类含量对AIHA的诊断价值,并采用Pearson相关分析AIHA患者免疫球蛋白与血细胞参数的关系。依据临床疗效标准将观察组患者分为缓解组及非缓解组,流式细胞仪检测2组外周血免疫细胞T细胞比例水平,采用Spearman相关分析AIHA患者免疫细胞与治疗疗效的关系。结果:观察组IgG1、IgG2、IgG3、IgG4含量、WBC水平明显高于对照组(P<0.05);RBC、HGB、HCT水平明显低于对照组(P<0.05);ROC曲线显示,单独检测IgG1、IgG3及联合检测IgG1、IgG2、IgG3和IgG4含量均可作为AIHA患者临床诊断的效能指标(P均<0.05);经Pearson相关分析,AIHA患者WBC水平与IgG1、IgG2含量呈反比(P<0.05),RBC、HGB、HCT水平与IgG1含量均呈正比(P<0.05);缓解组CD3;CD69;/CD3;比例、CD3;CD4;CD69;/CD3;CD4;比例明显高于非缓解组(P<0.05);经Spearman相关分析,AIHA患者CD3;CD69;/CD3;比例、CD3;CD4;CD69;/CD3;CD4;比例与临床疗效均具有正相关性(均P<0.05)。结论:AIHA患者外周血CD4;CD69;T细胞增高,且发病与IgG1、IgG3有关,尽早检测对其诊断及治疗均有重要意义。

Objective: To explore the clinical significance of detection of immune cells and immunoglobulins in patients with autoimmune hemolytic anemia(AIHA). Methods: A total of 60 patients with AIHA admitted to the hospital from June 2014 to October 2019 were selected as observation group, and 30 healthy people for physical examination during the same time period were set as control group. Red blood cell dispersion was used to detect immunoglobulin IgG subclasses and combined with the blood cell parameters(white blood cell[WBC], red blood cell[RBC], hemoglobin[HGB], hematocrit[HCT]), and the levels of IgG subclasses and blood cell parameters were compared between the two groups. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of each IgG subclass on AIHA, and Pearson correlation analysis was used to analyze the relationship between immunoglobulins and blood cell parameters in patients with AIHA. According to clinical efficacy criteria, the patients in observation group were divided into remission group and non-remission group. Flow cytometry was used to detect the proportions of peripheral blood immune cells and T cells in the two groups, and Spearman correlation analysis was applied to analyze the relationship between immune cells and treatment efficacy in patients with AIHA. Results: The levels of IgG1, IgG2, IgG3, IgG4 and WBC in observation group were significantly higher than those in control group(P<0.05). The levels of RBC, HGB and HCT were significantly lower than those in control group(P<0.05). ROC curve showed that single detection of IgG1 and IgG3 and the combined detection of IgG1, IgG2, IgG3 and IgG4 could be used as efficacy indicators for clinical diagnosis of patients with AIHA(all P<0.05). Pearson correlation analysis showed that WBC level in patients with AIHA was inversely proportional to IgG1 and IgG2(P<0.05), and levels of RBC, HGB and HCT were proportional to IgG1(P<0.05). The proportion of CD3;CD69;/CD3;and proportion of CD3;CD4;CD69;/CD3;CD4;in remission group were significantly higher than those in non-remission group(P<0.05). According to Spearman correlation analysis, the proportion of CD3;CD69;/CD3;and proportion of CD3;CD4;CD69;/CD3;CD4;in patients with AIHA were positively correlated with clinical efficacy(all P<0.05). Conclusion: The CD4;CD69;T cells were increased in peripheral blood of patients with AIHA, and the disease onset was associated with IgG1 and IgG3. Early detection might be of great significance for its diagnosis and treatment.