骨髓Coombs试验阳性血细胞减少症患者调节性T细胞数量及功能状态  

Quantity and function of regulatory T cells in hemocytopenic patients with positive BMMNC-Coombs test

作　　者：付蓉[1] 陈瑾[1] 王红蕾[1] 王珺[1] 李丽娟[1] 刘惠[1] 王一浩[1] 任悦[1] 邵宗鸿[1] 

机构地区：[1]天津医科大学总医院血液科,300052

出　　处：《中华医学杂志》2010年第42期2989-2993,共5页National Medical Journal of China

基　　金：基金项目：国家“十一五”科技支撑项目（2008BAl61BOO）;国家自然科学基金（30670886、30470749、30971285、30971286）;天津市科技支撑计划重点项目（07ZCGYSF00600）;天津市卫生局科技基金项目（03KZ26）;天津市应用基础及前沿技术研究计划（08JcYBJc07800）;天津市高等学校科研基金（200317）

摘　　要：目的 观察骨髓单个核细胞（BMMNC）Coombs试验阳性血细胞减少症（即免疫相关性血细胞减少症,IRP）患者骨髓调节性T（Treg）细胞数量及功能状态,探讨Treg细胞在IRP免疫发病中的作用.方法 选取2008年9月至2009年3月天津医科大学总医院血液科住院的初治IRP患者30例、经治疗达缓解或基本治愈（恢复期）IRP患者36例及健康对照24例.采用酶联免疫吸附试验（ELISA）法测定骨髓上清白细胞介素（IL）2、转化生长因子（TGF）β水平 采用流式细胞术（FCM）检测骨髓Treg细胞数量（CD4＋CD25＋/CD4＋）、Treg细胞激活状态（CD4＋CD25＋CD127low/CD4＋） 反转录-聚合酶链反应（RT-PCR）技术测定BMMNC中Treg细胞转录因子Foxp3、半乳糖凝集素10（galectin-10）mRNA的表达.结果 IRP初治组、恢复组骨髓IL-2[（5.6±1.7）、（6.2±2.5）μg/L]、TGF-β[（1.8±0.7）、（1.9±0.8）μg/L]均显著低于健康对照组[IL-2：（7.9±3.7）μg/L,TGF-β：（2.5±0.9）μg/L,均P〈0.05] 初治组骨髓CD4＋CD25＋/CD4＋（22.5%±9.5%）低于恢复组和健康对照组（27.1%±7.1%、30.6%±8.6%,均P〈0.05） 初治组骨髓CD4＋CD25＋CD127low/CD4＋（7.2%±2.7%）明显低于恢复组和健康对照组（9.1%±4.7%、10.4%±3.2%,均P〈0.05）.初治组BMMNC Foxp3 mRNA相对表达量（0.34±0.25）低于恢复组和健康对照组（0.69±0.51、0.82±0.66,P〈0.05）,galectin-10 mRNA相对表达量（0.66±0.11）低于恢复组和正常对组（0.74±0.11、0.76±0.09,均P〈0.05）.结论 IRP患者Treg细胞数量和功能异常可能在IRP免疫发病机制中发挥重要作用.Objective To investigate the quantity and function of regulatory T cells in immunorelated pancytopenia （IRP）and explore the significance of Treg cells in the pathogenesis of IRP. Methods Sixty-six IRP patients and 24 healthy donors were enrolled. The levels of IL-2 and TGF-β were detected by ElISA. The ratios of CD4＋ CD25 ＋/CD4＋ and CD4＋ CD25＋ CD127low/CD4＋ in bone marrow were examined with flow cytometry. The expressions of Foxp3 and galectin-10 mRNA in BMMNC were measured by semi-quantitative RT-PCR. Results The levels of IL-2 and TGF-β in bone marrow of untreated or recovered IRP patients[（5.6±1.7） 、（6.2±2.5） μg/L,（1.8±0.7）、（1.9±0.8）μg/L]were significantly lower than those of healthy controls [（7.9±3.7）、（2.5±0.9）μg/L, all P〈 0.05]. The ratio of CD4 ＋ CD25 ＋/CD4＋ cells in bone marrow of untreated IRP patients （22.5%±9.5%） was significantly lower than that of recovered IRP patients or healthy controls （27.1% ±7.1% 、30.6%±8.6% ,both P〈0.05）. The ratio of CD4＋ CD25 ＋ CD127low/CD4 ＋ cells in bone marrow of untreated IRP patients was significantly lower than that of recovered IRP patients or healthy controls （7.2%±2.7% vs 9.1%±4.7% 、10.4%±3.2% ,both P 〈0.05）. The relative mRNA expressions of Foxp3 and galectin-10 were 0.34 ±0.25, 0.69±0.51, 0.82±0.66 and 0.66±0.11, 0.74±0.11,0.76±0.09 in three groups respectively. The expressions of two factors in untreated IRP patients were significantly lower than those in recovered IRP patients or normal controls （all P 〈 0.05）. Conclusion The abnormalities in quantity and function of Treg cells in IRP patients might play an important role in the pathogenesis of IRP.

关 键 词：全血细胞减少 COOMBS试验 免疫性疾病 T淋巴细胞 调节性 

分 类 号：R686[医药卫生—骨科学]