三氧化二砷联合沙利度胺对骨髓增生异常综合征患者免疫功能的影响  

Effects of arsenic trioxide plus thalidomide on immune function in patients with myelodysplastic syndrome

作　　者：张秋荣[1] 陈令松[1] 王静霞[1] 张桂华[1] 徐金格[1] 宋文炜[1] 

机构地区：[1]徐州医学院第二附属医院血液科,221006

出　　处：《中国综合临床》2013年第12期1243-1246,共4页Clinical Medicine of China

基　　金：徐州市科技指导计划项目（XZZD1048）

摘　　要：目的探讨三氧化二砷和沙利度胺对骨髓增生异常综合征（MDS）患者免疫功能的影响。方法采用流式细胞术（FCM）检测57例MDS患者（低危、中危和高危）和30名健康志愿者外周血淋巴细胞亚群，将其中34例中危Ⅱ和高危MDS患者随机分为A、B两组，每组17例，A组使用三氧化二砷和沙利度胺治疗，B组使用小剂量阿糖胞苷治疗，比较两组的疗效，观察三氧化二砷和沙利度胺的不良反应，并比较治疗前后淋巴细胞亚群的变化。结果与健康对照组比较，MDS患者的T淋巴细胞（CD3’）、B淋巴细胞（CD3-CD19’）和NK细胞[CD3-（CDl6CD56）’]总数均明显低于正常人，差异均有统计学意义（t值分别为2．157，2．349，2．958；P〈0．05或P〈0．01）。在T淋巴细胞亚群中，CD3’CD4’的辅助性T细胞（Th）表达降低（t=2．412，P〈0．05），CD3’CD8’的抑制性T细胞（Ts）表达增高（t=2．749，P〈0．01），Th／Ts比值倒置，比例失衡；且随着MDS疾病的进展，Ts细胞的表达逐渐增加，NK细胞的表达逐渐降低，但3组间的差异无统计学意义，另中危组的Th细胞和B淋巴细胞表达低于低危组，且差异有统计学意义（F值分别为4．896和4．516，P均〈0．05），MDS各组间T淋巴细胞、Th细胞、Th／Ts比值和B淋巴细胞的差异均无统计学意义（P均〉0．05）。A组治疗后T淋巴细胞、B淋巴细胞和NK细胞总数均有一定程度增加（t值分别为2．435、2．468、2．653，P均〈0．05）。A组获完全缓解2例，部分缓解4例，血液学改善5例，总有效率为64．71％（11／17），疗效明显好于B组（总有效率为35．29％），差异有统计学意义（x2=4．253，P〈0．05），且不良反应轻微。结论MDS患者的细胞和体液免疫功能均降低，使用三氧化二砷和沙利度胺治疗MDS安全有效，可能与改善患者免疫功能状态有关。Objective To investigate the effects of arsenic trioxide plus thalidomide on immune function of patients with myelodysplastic syndrome （ MDS）. Methods Fifty-seven MDS patients （ Low risk, medium risk and high risk） and 30 healthy volunteers were selected as our subjects. Thirty-four cases with medium risk Ⅱ and high risk MDS patients were randomly divided into A and B groups. Seventeen MDS patients in A group were treated with arsenic trioxide plus thalidomide, and 17 MDS patients in B group were treated with low-dose cytarabine. Lymphocyte subsets in peripheral blood were examined by flow cytometry （FCM）. The adverse effect of arsenic trioxide and thalidomide were recorded. Results Compared with control group, the number of T lymphocytes（ CD3 ） , B lymphocytes （CD3- CD19 ） and NK cell （CD3- （CD16 CD56） ） of patients with MDS were significantly lower, and the differences were statistically significant （t = 2. 157,2. 349, 2. 958 ; P 〈 0. 05 or P 〈 O. 01 ）. The helper CD3 CIM T cell（Th） ratio decreased in MDS patients than that of control group （t = 2. 412, P 〈 0. 05 ）. The inhibition CD3 CD8 T cells （Ts） ratio increased （ t = 2. 749, P 〈 0. 01 ）. Th/Ts ratio inversion was seen in MDS patients. As the progression of MDS increase, Ts cell expression gradually increased and NK cells ratio gradually decreased. However, there was no significant difference among three groups. Th ceils and B lymphocytes in the risk group were lower than that in the low risk group, and the difference was statistically significant （ F = 4. 896 and 4. 516, P 〈 0. 05 ）, but there was no significant difference in the terms of the number of T lymphocytes, Th cell, ratio of Th/Ts and B lymphocytes among MDS groups. Number of T lymphocytes, B lymphocytes and NK cell count in group A after treatment were increased than that before treatment （ t = 2. 435,2. 468,2. 653,P 〈 0. 05 ）. In group A ,2 cases were complete remission,4 cases with partial remission, and 5 cases with

关 键 词：三氧化二砷 沙利度胺 骨髓增生异常综合征 流式细胞术 免疫功能 

分 类 号：R551.3[医药卫生—血液循环系统疾病]