急性白血病患者DC和辅助性T细胞及B细胞比例与活化状态研究

Study on the proportion and activation status of DC,helper T cells and B cells in patients with acute leukemia

目的 探讨急性白血病(AL)患者外周血髓系起源的树突状细胞(mDC)和淋巴系起源的树突状细胞(pDC)以及辅助性T细胞(Th)、滤泡辅助性T细胞(Tfh)、初始B细胞、记忆B细胞比例及其活化状态。方法 收集2022年1月-2023年8月在中山大学附属第一医院血液内科住院的B细胞-急性淋巴细胞白血病(ALL)患者13例以及急性髓细胞白血病(AML)患者15例,同时选取心脏瓣膜病等非肿瘤、非自身免疫性疾病患者12例为对照组。所有患者的治疗均根据国内指南规范化进行,整个治疗过程中均使用常规类似化疗方案。采用流式细胞仪方法研究B细胞-ALL、AML患者外周血起病时(起病组)、缓解后(缓解组)mDC、pDC的比例及活化状态,以及Th、Tfh、初始B细胞、记忆性B细胞比例。结果 ALL、AML患者起病组pDC、mDC比例[(0.43±0.05)%、(0.28±0.04)%,(0.26±0.06)%、(0.19±0.03)%]较对照组[(0.67±0.04)%、(0.48±0.05)%]明显降低,差异均有统计学意义(P均<0.05);缓解组有上升。ALL患者起病组pDC、mDC的CD80、CD86的表达较对照组有增高的趋势,在缓解组均有下降的趋势;AML患者起病组pDC、mDC的CD80、CD86的表达较对照组均有降低的趋势,在缓解组均有恢复的趋势。ALL起病组外周血Th、Tfh、初始B细胞比例[(6.45±0.56)%、(0.24±0.06)%、(34.85±2.23)%]较对照组[(8.47±0.72)%、(0.60±0.08)%、(48.43±3.70)%]明显降低,差异均有统计系意义(P均<0.05);记忆性B细胞有下降的趋势;而缓解组均有恢复的趋势。AML患者起病组外周血Th、Tfh、初始B细胞、记忆性B细胞比例[(7.61±0.56)%、(0.43±0.05)%、(39.47±1.77)%、(16.28±0.89)%]均较对照组[(8.47±0.72)%、(0.60±0.07)%、(48.43±3.70)%、(19.88±1.63)%]降低,其中初始B细胞差异有统计学意义(P<0.05);缓解组也均有回升的趋势。结论 AL患者的mDC、pDC、Th、Tfh、初始B细胞、记忆B细胞的比例在起病时均受到抑制,缓解后有恢复的趋势,其机制及相互作用需做进一步研究。

Objective To investigate the percentage of myeloid dendritic cell(mDC),plasmacytoid dendritic cell(pDC),helper T cell(Th),T follicular helper(Tfh),naive B cells,memory B cells and their activation status in acute leukemia(AL).Methods A total of 13 patients with B-cell acute lymphocyte leukemia(ALL)and 15 patients with acute myeloid leukemia(AML)admitted to the Department of Blood Transfusion,the First Affiliated Hospital of Sun Yat-sen University from January 2022 to August 2023 were selected for the study;at the same time,patients with non-tumor and non-autoimmune diseases,such as valvular heart disease,were selected as the control group.All the patients were treated according to the national guidelines,and the similar chemotherapy regimen was used in the whole treatment process.The proportion and activation of mDC and pDC in peripheral blood of patients with B-ALL and AML at onset group and remission group were tested by flow cytometry,as well as Th,Tfh,naive B cells,memory B cells proportion.Results The proportion of pDC and mDC decreased in onset group in ALL and AML patients[(0.43±0.05)%,(0.28±0.04)%;(0.26±0.06)%,(0.19 ± 0.03)%]were obviously lower than those of control group [(0.67 ± 0.04)%,(0.48 ± 0.05)%],the differences were statistically significant(all P<0.05);but increased in remission group.The expression of CD80 and CD86 of pDC and mDC of onset group in ALL patients was higher than those of control group,and decreased in remission group.The expression of CD80 and CD86 of pDC and mDC of onset group in AML patients tended to decrease compared with the control group,and to recover in the remission group.The Th,Tfh and the ratio of naive B cells in peripheral blood in the onset group in ALL patients[(6.45±0.56)%,(0.24±0.06)%,(34.85±2.23)%]were obviously lower than those of control group[(8.47±0.72)%,(0.60±0.08)%,(48.43±3.70)%],the differences were statistically significant(all P<0.05).The ratio of memory B cells showed a decreasing trend;there was an upward trend in the remission group.The percentage of Th,Tfh,naive B cells and memory B cells in the peripheral blood at onset group of AML patients[(7.61±0.56)%,(0.43±0.05)%,(39.47±1.77)%,(16.28±0.89)%]were lower than those of the control group[(8.47±0.72)%,(0.60±0.07)%,(48.43±3.70)%,(19.88±1.63)%];among them,the proportion of naive B cells was decreased significantly(P<0.05),but the remission group also had the upward trend.Conclusion The percentages of mDC,pDC,Th,Tfh,naive B cells and memory B cells were inhibited at the onset of acute leukemia;there was a tendency to recover after remission;these mechanisms and interactions needed further studies.