IL-18和IL-18结合蛋白在骨髓增生异常综合征中的临床意义

Clinical significance of IL-18 and IL-18-binding protein in bone marrow of patients with myelodys-plastic syndrome

目的分析IL-18、IL-18结合蛋白(IL-18BP)在骨髓增生异常综合征(MDS)患者骨髓液中的表达水平及临床意义。方法纳入2020年7月至2021年2月天津医科大学总医院血液科收治的初诊MDS患者43例,对照组包括急性髓系白血病(AML)患者14例、缺铁性贫血(IDA)患者25例,检测骨髓上清中IL-18和IL-18BP水平,分析其与MDS的严重程度、CD8^(+)T细胞及NK细胞功能的相关性。结果MDS患者骨髓上清中IL-18、IL-18BP和游离IL-18(fIL-18)的水平均高于IDA组,fIL-18的水平与MDS-IPSS评分呈线性负相关。MDS患者CD8^(+)T细胞表面IL-18受体(IL-18Rα)表达低于IDA组,fIL-18及IL-18Rα水平均与MDS患者CD8^(+)T细胞功能呈正相关。结论IL-18在MDS患者骨髓微环境中表达增加,但由于IL-18BP的存在导致fIL-18相对减少,与MDS疾病严重程度和CD8^(+)T细胞功能减低有关。

Objective To analyze the level and clinical significance of IL-18 and IL-18-binding protein(BP)in the bone marrow of patients with myelodysplastic syndrome(MDS).Methods A total of 43 newly diagnosed patients with MDS who were admitted to the Department of Hematology,Tianjin Medical University General Hospital,from July 2020 to February 2021 were randomly selected.The control group consisted of 14 patients with acute myeloid leukemia(AML)and 25 patients with iron-deficiency anemia(IDA).The levels of IL-18 and IL-18 BP in the bone marrow supernatant were measured,and their correlations with MDS severity,as well as the functionality of CD8^(+)T cells and natural killer cells,was analyzed.Results The levels of IL-18,IL-18 BP,and free IL-18(fIL-18)in the bone marrow supernatant of patients with MDS were higher than in the IDA group.The level of fIL-18 was linearly and negatively correlated with the MDS-International Prognostic Scoring System(IPSS)score.IL-18 receptor(IL-18Rα)expression on CD8^(+)T cells in the MDS group was lower than in the IDA group,and the levels of fIL-18 and IL-18Rαwere positively correlated with CD8^(+)T-cell function in the MDS group.Conclusion IL-18 BP antagonizes IL-18,leading to a decrease in fIL-18 in the bone marrow microenvironment of patients with MDS,affecting CD8^(+)T-cell function,which is closely related to MDS severity;therefore,it may become a new target for MDS treatment.