骨髓单个核细胞Coombs试验阳性血细胞减少患者滤泡辅助性T细胞数量及功能初步研究  

Preliminary study on the quantity and function of T follicular helper cells in the cytopenic patients with positive BMMNC-Coombs test

作　　者：于虹[1] 付蓉[1] 王一浩[1] 王化泉[1] 刘惠[1] 李丽娟[1] 王红蕾[1] 阮二宝[1] 瞿文[1] 王晓明[1] 王国锦[1] 吴玉红[1] 刘鸿[1] 宋嘉[1] 邢莉民[1] 关晶[1] 邵宗鸿[1] 

机构地区：[1]天津医科大学总医院血液内科,300052

出　　处：《中华血液学杂志》2013年第7期606-609,共4页Chinese Journal of Hematology

基　　金：国家自然科学基金（30971285、30971286、30670886）;天津市卫生行业重点攻关项目（11KG135）;卫生公益性行业科研专项（201202017）;天津市自然科学基金（08JCYBJC07800、09JCYBJC11200）;天津市卫生局科技基金（2011KZ115、2010KZ105）

摘　　要：目的研究骨髓单个核细胞（BMMNC）Coombs试验阳性血细胞减少（又称免疫相关性血细胞减少，IRP）患者骨髓滤泡辅助性T细胞（Tm细胞）数量及功能，探讨Tfh细胞在IRP中的作用。方法选取90例IRP患者及25名正常对照，采用流式细胞术检测骨髓Tfh细胞数量、Tfh细胞功能相关分子CD40L、ICOS、IL-21的表达；采用RT—PCR技术检测BMMNC转录因子Bcl-6 mRNA相对表达水平。结果IRP初诊组骨髓CD4^＋CXCR5^＋／CD4^＋细胞比例[（28．79±19．70）％]高于恢复组[（21．15±12．81）％]和正常对照组[（13．42±6．72）％]（P〈0．05）；IRP初诊组骨髓CD4^＋CXCR5^＋ICOS^＋／CD4^＋CXCR5^＋细胞比例[（5．05±4．71）％1高于恢复组（2．96±2．89）％]和正常对照组[（2．99±2．23）％]（P〈0．05）；IRP初诊组和恢复组骨髓CD4^＋CXCR5^＋CD40L^＋／CD4^＋CXCR5^＋细胞比例[（5．87±4．14）％及（6．52±5．47）％]高于正常对照组[（2．93±2．92）％]（P〈0．05）；IRP初诊组骨髓CD4^＋CXCR5^＋IL-21^＋／CD4^＋CXCR5^＋细胞比例[（8．20±7．41）％]高于恢复组[（6．30±6．03）％]和正常对照组[（3．43±3．40）％]（P〈0．05）；初诊组、恢复组、正常对照组三组Bcl-6 mRNA的表达水平分别为0．625±0．248、0．485±0．253和0．306±0．210，差异均有统计学意义（P值均〈0．05）。结论Tfh细胞在IRP患者骨髓中数量增加，功能亢进，在IRP发生机制中可能发挥重要作用，Tfh细胞及其效应分子有町能成为IRP潜在的治疗靶点。Objective To study the quantity and function of bone marrow （BM） T follicular helper （Tfh） cells of the cytopenic patients with positive bone marrow mononuclear cells （BMMNC）- Coombs test （also known as immuno-related pancytopenia, IRP）, and explore the role of Tfh cells in the pathogenesis of IRP. Methods Forty-three untreated IRP patients, 47 recovered IRP patients and 25 healthy donors were enrolled in this study. The percentages of Tfh cells, Tfh-related molecules ICOS, CD40L, IL-21 and Bcl-6 in BM were investigated by flow cytometry and semiquantitive RT-PCR. Results The ratio of CD4＋CXCR5 ＋/CD4＋ cells of untreated IRP patients [ （28.79± 19.70）%] was significantly higher than that of recovered IRP patients [（21.15±12.81）%] and normal controls [（13.42±6.72）%] （P〈0.05）. The ratio of CD4＋ CXCR5 ＋ ICOS ＋/CD4 ＋ CXCR5 ＋ cells of untreated IRP patients [ （5.05 ± 4.71 ） % ] was significantly higher than that of recovered IRP patients [（2.96±2.89）% ] and normal controls [（2.99± 2.23 ） % ] （P〈0.05）. The ratio of CD4 ＋ CXCR5 ＋ CD40L ＋/CD4 ＋ CXCR5＋ cells of untreated IRP patients [（5.87± 4.14）%] and recovered IRP patients [（6.52±5.47）%] were significantly higher than that of normal controls [ （ 2.93±2.92 ） %] （P〈0.05）. The ratio of intracytoplasm CD4＋CXCR5 ＋IL-21 ＋/CD4＋CXCR5＋ cells of untreated IRP patients[ （ 8.20 ± 7.41 ） % ] and recovered IRP patients [ （6.30 ± 6.03 ） % ] were significantly higher than that of normal controls [ （3.43±3.40）%] （P〈0.05）. The relative expressions of Bcl-6 mRNA in BMMNC were 0.625 ±0.248, 0.485 ±0.253, 0.306±0.210 in three groups, respectively. The differences between untreated IRP patients, recovered IRP patients and normal controls were significant （P〈0.05）. Conclusions There exists increased quantity and hyperfunction of Tfh cells in the IRP patients, they may play important role in the pathogenesis of IRE Tfh cells and their related effector

关 键 词：COOMBS试验 全血细胞减少 滤泡辅助性T细胞 自身抗体 

分 类 号：R55[医药卫生—血液循环系统疾病]