免疫相关性血细胞减少患者骨髓造血细胞端粒酶活性检测的临床意义  

Clinical significance of telomerase activity detection of myeloid element in immune related hematocytopenia

作　　者：孙黎飞 韩冰 吴强强 刘长伟 李钢 马向杉 郝红峰 

机构地区：[1]解放军第一四八医院济南军区肿瘤专科中心,山东省淄博市255300

出　　处：《中华医学杂志》2012年第36期2530-2533,共4页National Medical Journal of China

基　　金：济南军区“十二五”重点支持项目（JN11L017）

摘　　要：目的观察免疫相关性血细胞减少和全血细胞减少（IRH／IRP）患者治疗前后骨髓单个核细胞（BMMNC）端粒酶活性变化，探讨端粒酶活化与该类疾病的关联及临床意义。方法端粒重复序列扩增-酶联免疫吸附法（TRAP-PCR-ELISA）检测108例IRH／IRP患者BMMNC的端粒酶活性，免疫荧光染色观察患者骨髓细胞抗人IgG、FcγⅡ受体（FcγⅡR）、白细胞介素17A（IL-17A）和甘露糖受体（MR）表达，30例缺铁性贫血患者作为疾病对照。结果IRH／IRP患者治疗前端粒酶活性为0．251±0．021，高于疾病对照组（0．062±0．031，P〈0．01）；其中HIA-B27＋患者高于HLA-B27-患者（0．270．4-0．020比0．181．4-0．013，P〈0．05），HIJA．B27＋IgG升高的重度IRP患者显著高于HLA-B27-IgG升高患者（0．341-4-0．016比0．183±0．010，P〈0．01）。IRH／IRP患者骨髓中可见抗人IgG抗体阳性的幼稚血细胞，IgG升高者骨髓中活化的巨噬细胞（Mφ）高表达FcγIIR，HLA-B27＋患者骨髓活化的树突细胞和Mφ高表达IL-17A和MR。经糖皮质激素联合环孢素A等药物治疗后患者血象恢复时,BMMNC的端粒酶重新失活。结论IRH／IRP患者骨髓BMMNC端粒酶活性增强，其活化的强度与免疫细胞活化的群体对病变造血细胞病理性损害程度相关，具有同步性和均衡性。Objective To observe the telomerase activity （TA） in bone marrow mononuclear cell （BMMNC） at pre-therapy and post-therapy in patients with immune related hematocytopenia and immune related pancytopenia （IRH/IRP） so as to explore the relationship between TA and disease process. Methods TA in BMMNC of 108 IRH/IRP patients was detected with telomeric repeat amplification protocol （TRAP）-PCR-ELISA. The expressions of anti-human immunoglobulin IgG, FcγⅡ receptor （FcγⅡ R）, mannose receptor （MR） and interleukin 17A （IL-17A） located on membrane surface were observed by immunofluorescence（IF）. A total of 30 iron deficiency anemia patients were selected as case control. Results The TA of 108 IRH/IRP patients were 0. 251 ±0. 021. And it increased as compared with the control group of 0. 062 ± 0. 031 at pre-therapy （ P 〈 0.01 ）. The HLA-B27 ＋ patients among them was 0. 270 ± 0. 020 while HLA-B27 - patients 0. 181 ＋ 0. 013 （ P 〈 0. 05 ）. And HLA-B27 ＋ IgG elevated IRP was 0. 341 ±0. 016 and HLA-B27 - IgG elevated 0. 183 -＋0. 010,the difference of TA was significant between two groups （P 〈 0. 01 ）. IgG antibody positive immature hemocyte could be observed in marrow of IRH/IRP patients, and Fc,/II R was expressed highly on those activated macrophage （Mq~） in bone marrow. Both IL-17A and MR were expressed on activated dendritic cells and My in marrow of HLA-B27 ＋ patients. After the therapy of glucocorticoids associated with cyclosporine A and other drugs, the patient＇s hemogram recovered and the telomerase in BMMNC were re-devitalized. Conclusions The TA of the BMMNC in marrow of IRH/IRP patients is increased, and it shows a close relation between apoptotic degree of hematopoietic cell and the activation of immunocytes. In IRH/IRP, synchronism and equilibrium exist between BMMNC apoptosis and TA.

关 键 词：端粒 末端转移酶 HLA-B27抗原 白细胞介素17 免疫相关性血细胞减少 

分 类 号：R446.6[医药卫生—诊断学]