重型再生障碍性贫血免疫抑制治疗疗效预测指标的研究  

Studies on the Predictors of Response to Immunosuppressive Therapy in Severe Aplastic Anemia Patients

作　　者：牟晓艳[1] 常红[1] 刘霆[1] 龚玉萍[1] 牛挺[1] 秦慧[1] 马洪兵[1] 孟文彤[1] 

机构地区：[1]四川大学华西医院血液科,成都610041

出　　处：《四川大学学报（医学版）》2009年第5期897-900,共4页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅基金(批准号05SG022-018-5)资助

摘　　要：目的探索可能用于重型再生障碍性贫血(再障)免疫抑制治疗(IST)疗效预测的指标。方法收集37例重型再障患者的静脉血标本,20例健康献血员作为正常对照。采用酶联免疫吸附实验检测血浆内白介素-2(IL-2)及干扰素-γ(IFN-γ)水平,采用序列特异引物聚合酶链反应检测HLA-DRB1*15及HLA-DRB1*1501,结合年龄、性别及粒细胞和红细胞膜表面CD55、CD59表达情况等,对各项指标与疗效的关系进行统计分析。结果治疗前IL-2水平升高者有效率高于水平降低者(66.7%vs28.6%,P<0.05);治疗前IFN-γ水平升高者有效率高于水平降低者(73.7%vs25.0%,P<0.05);HLA-DRB1*15阳性者有效率与阴性者差异无统计学意义(62.5%vs44.4%,P>0.05);HLA-DRB1*1501阳性者与阴性者有效率均为50%;CD55、CD59表达降低者有效率与表达未降低者差异无统计学意义(80.0%vs40.0%,P>0.05);年龄≤40岁者有效率高于年龄>40岁者(60.0%vs14.3%,P<0.05);女性患者有效率高于男性患者(62.5%vs42.9%,P<0.05)。结论重型再障患者治疗前血浆IL-2、IFN-γ水平、性别及年龄可作为IST疗效预测指标,而HLA-DRB1*15、HLA-DRB1*1501及CD55、CD59在本研究中不具有预测作用。Objective To assay the factors that may predict the response to immunosuppressive therapy （IST） in severe aplastic anemia patients. Methods The blood samples were collected from 37 patients diagnosed as severe aplastic anemia in West China Hospital of Sichuan University and West China Second Hospital of Sichuan University during February, 2006 to March, 2007. Twenty healthy blood donors were used as normal control. The plasma levels of IFN-γ and IL-2 were measured by enzyme linked immunosorbent assay, and the gone phenotype of HLA-DRB 1 ＊ 15 and HLA-DRB 1 ＊ 1501 was analyzed by polymerase chain reaction with sequence specific primer. The expressions of CD55 and CD59 on the cellular membrane of red blood cell and white blood cells also were measured. Results The response rate in the patients who had higher IL-2 level before IST was significantly better than that in the patients with lower IL-2 level（66.7% vs 28.6 %, P〈0.05）, while similar result was observed to IFN-γ（73.7% vs 25.0% ,P〈0.05）. The response rate in the patients with positive HLA-DRB1 ＊ 15 was higher than that in those negative patients （62.5 % vs 44. 4%, P〉0.05）, but there was no different found in different HLA-DRB1 ＊ 1501 phenotypes （50% vs 50%, P〉0.05）. The response rates in the patients with deficient CD55 and CD59 expression were higher than those expressed CD55 and CD59 normally（80.0% vs 40.0% ,P〉0.05） ; the response rate of patients younger than 40 years was higher than those older than 40 years（60.0% vs 14.3%, P〈 0. 05） ; the response rate in female patients was higher than male patients（62.5% vs 42. 9%, P〈0.05）. Conclusion The concentration of IL-2, IFN-γ before IST, and age can be used as the predicting factors to immunosuppressive therapy, while the predicting value of HLA-DRB1 ＊ 15, HLA- DRB1 ＊ 1501 and CD55, CD59 to the response of IST still remain unclear.

关 键 词：白介素-2 干扰素-Γ 再生障碍性贫血 免疫抑制治疗 

分 类 号：R556.5[医药卫生—血液循环系统疾病]