急性白血病患者T细胞亚群的变化及其与临床特征和预后的关系  

Changes of T Cell Subsets and Their Relationship with Clinical Features and Prognosis in Patients with Acute Leukemia

作　　者：郑润辉[1] 于宝丹[1] 郑丽霞[1] 王春燕[1] 覃鹏飞[1] 罗晓丹[1] 林竞韧[1] 谭获[1] 徐军[2] ZHENG Run-Hui;YU Bao-Dan;ZHENG Li-Xia;WANG Chun-Yan;QIN Peng-Fei;LUO Xiao-Dan;LIN Jing-Ren;TAN Huo;XU Jun(Department of Hematology,The First Ajfiliated Hospital of Guangzhou Medical University,Guangzhoo 510230,Guangdong Province,China;Guangzhoo Institute of Respiratory Disease,Guangzhou 5 10230,Guangdong Province,China)

机构地区：[1]广州医科大学附属第一医院血液内科,广东广州510230 [2]广州呼吸疾病研究所,广东广州510230

出　　处：《中国实验血液学杂志》2018年第5期1309-1316,共8页Journal of Experimental Hematology

摘　　要：目的:探讨急性白血病患者T细胞亚群的变化及其与临床特征的关系。方法:收集103例急性白血病患者起病、完全缓解、复发等不同阶段的外周血标本,使用流式细胞仪检测T细胞亚群及Treg细胞比例,分析T细胞亚群与疾病状态、预后及治疗效果的关系。结果:骨髓原始细胞大于50%的患者,CD3^+T细胞水平明显低于原始细胞小于50%的患者。白血病细胞CD34^+患者,其Treg比例明显高于CD34^-患者;对比低、中和高危3组患者预后与免疫细胞的关系发现,高危组Treg细胞较低危组明显升高; 18例患者通过连续监测细胞免疫动态发现,Treg细胞前3个疗程化疗过程逐渐升高,到第4疗程逐渐下降,至第6疗程逐渐接近正常值,且与患者临床疗效相关;急性白血病患者总体Treg水平明显高于健康对照者,而且在起病、复发时明显高于完全缓解期;急性髓细胞白血病Treg细胞上调比急性淋巴细胞白血病更加明显;首疗程化疗完全缓解(CR)组Treg细胞比例明显低于非CR组。Treg细胞大于10%的患者,首疗程完全缓解率为68. 9%。Treg细胞小于10%为85. 7%。随访发现高Treg细胞组复发率20%,低Treg细胞组复发率为7. 69%,对比6例复发患者与32例持续CR患者的Treg比例、Treg/CD4比值发现,复发组Treg比例、Treg/CD4比值明显高于完全缓解组及对照组。结论:外周血调节性T细胞水平的动态变化与急性白血病患者的临床特征、复发及预后等密切相关。Objective:Toanalyze the relationship between Tcell subsets and clinical data.Methods:mononuclear cells were collected from 103 patients with acute leukemia(AL)and 28 healthy volunteers,and percentage changes of CD3+CD4+,CD3+CD8+and CD4+CD25+Foxp3+cell subsets were assayed by flow cytometory.Relationship between the T subsets and clinical features of the patients was analyzed.Results:Ratio of CD3+T cells decreased more significantly in patients with>50%blast cells than that in patients with<50%blast cells,while the ratio of Treg between the 2 groups was not significantly different.Treg increased more statistically significantly in the patients with CD34+leukemia cell than that with CD34-leukemia cells.In contrast to the relationship between prognosis and immune cells in the patients from 3 groups(low,intermediate and high-risk group)it was found that Treg cells increased more significantly in high-risk group than that in low-risk group.By continuously monitoring immune cells in 18patients,it was found that Treg cells gradually increased during the first 3 courses of chemotherapy,then began to decreased in the 4th course,finally approached gradually to the normal value in the 6th course,and this change correlated with the clinical remission after chemotherapy.Treg cell number in the patients with AL was significantly higher than that in healthy controls,and Treg cell number during the onset and recurrence was significantly higher than that in the period of complete remission(continuous remission for over 6 months).Compared with the changes of immune cell number between different types of disease,it was found that Treg cells were increased more significantly in acute myeloid leukemia(AML)than that in acute lymphoblastic leukemia(ALL).Proportion of Treg cells,Treg/CD4 decreased more significantly after the 1st course of chemotherapy in the group with complete remission(CR)than that in the group without CR.The complete remission rate and recurrence rate were 68.9%and 20%respectively in the group with>10%Treg cells,whi

关 键 词：急性白血病 T细胞亚群 调节性T细胞 

分 类 号：R733.71[医药卫生—肿瘤]