T细胞亚群与细胞因子水平变化在多发性骨髓瘤患者临床诊疗及预后评估中的价值  被引量:13

The Value of T Cell subsets and Cytokine Levels Changes in the Clinical Diagnosis, Treatment and Prognosis Evaluation of Multiple Myeloma

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作  者:严志民[1] 刘彦权 黄走方[1] 梁艳[1] 林洁[2] 沈建箴[3] 陈鑫基[3] YAN Zhi-Min;LIU Yan-Quan;HUANG Zou-Fang;LIANG Yan;LIN Jie;SHEN Jian-Zhen;CHEN Xin-Ji(Department of Hematology,The First Affiliated Hospital of Gannan Medical University,Ganzhou Key Laboratory of Hematology;Department of Intensive Medicine,The First Affiliated Hospital of Gannan Medical University,Jiangxi Provincial Key Clinical Specialized Department of Intensive Medicine,Ganzhou 341000,Jiangxi Province,China;Department of Hematology,Fujian Medical University Union Hospital,Fujian Institute of Hematology,Fuzhou 350001,Fujian Province,China)

机构地区:[1]赣南医学院第一附属医院血液内科,赣州市血液病重点实验室 [2]赣南医学院第一附属医院重症医学科,江西省临床重点专科重症医学科,江西赣州341000 [3]福建医科大学附属协和医院血液科、福建省血液病研究所,福建福州350001

出  处:《中国实验血液学杂志》2022年第6期1791-1796,共6页Journal of Experimental Hematology

基  金:江西省卫健委科技项目(SKJP520201086-202130697);江西省教育厅科学技术研究立项课题(GJJ211530);国家临床重点专科建设项目(闽卫医政2021-76号);福建省恶性血液病临床医学研究中心(2020Y2006)。

摘  要:目的:探讨多发性骨髓瘤(MM)患者T淋巴细胞亚群及细胞因子的变化与免疫功能状态、生化指标的相关性以及与临床病情阶段及预后的关系,为MM患者预后分析及病情监测提供科学依据。方法:收集两家医院共89例MM患者的临床资料,同时选取36例健康者为对照组,采用流式细胞术、酶联免疫吸附试验(ELISA)分别检测入组患者外周血T淋巴细胞亚群核心成员及细胞因子的水平,同时应用全自动生化分析仪与全自动血细胞分析仪检测血清β_(2)-微球蛋白(β_(2)-MG)、乳酸脱氢酶(LDH)、白蛋白(ALB)、肌酐(CRE)以及血红蛋白(HGB)水平,并探究T淋巴细胞亚群与上述各指标之间的关系及其临床意义。结果:MM患者外周血中NK细胞、CD8^(+)T淋巴细胞数显著高于对照组(P<0.01),CD4^(+)T、CD4^(+)/CD8^(+)比值低于对照组(P<0.05);而MM患者外周血中CD3^(+)T细胞数与对照组比较无显著统计学差异(P>0.05)。MM患者CD4^(+)T、CD4^(+)/CD8^(+)比值低于正常对照,且与MM分期呈负相关(r=-0.964,r=-0.653),即MM分期越晚其水平减低越明显;而CD8^(+)T、NK细胞比例则与MM分期呈正相关(r=0.891,r=0.728),即MM分期越晚其水平升高越显著。MM患者Treg细胞(CD4^(+)CD25^(high)CD127^(low/-)T细胞/CD4^(+)T细胞)水平在疾病分期Ⅰ期、Ⅱ期、Ⅲ期分别为(5.87±0.92)%、(7.97±1.32)%、(11.52±4.71)%,与对照组比较差异有统计学意义(P<0.05),且Ⅲ期MM患者Treg细胞水平显著高于对照组及其他病情阶段的患者(P<0.01)。MM患者Treg细胞(CD4^(+)CD25^(high)CD127^(low/-)T细胞/CD4^(+)T细胞)的比例与β2-MG浓度、LDH水平呈正相关性(r=0.793,r=0.536),但与HGB、ALB以及CRE无显著性相关性。MM患者血清IL-6、IL-10、TNF-α水平显著高于对照组(P<0.05),与MM分期密切相关(r=0.839,r=0.917,r=0.746),即MM分期越晚,其水平越高;而血清IFN-γ水平与MM疾病分期呈负相关(r=-0.689),随疾病分期增加其水平逐渐减低(P<0.01);IL-2、IL-4水平�Objective: To explore the correlation between the changes of T lymphocyte subsets and cytokines in patients with M M and immune function status,biochemical indicators,and their relationships with clinical stage and prognosis,which is expected to provide a scientific basis for the prognosis analysis and condition monitoring of M M patients.Methods: The clinical data of 89 M M patients in two hospitals were collected,and 36 healthy people without tumor or infectious diseases were selected as the control group.Flowcytometry and enzyme-linked immunosorbent assay(ELISA) were used to detect the changes of core members of peripheral blood T lymphocyte subsets and cytokine levels,respectively.At the same time,automatic biochemical analyzer and automatic blood cell analyzer were used to detect serum β_(2)-microglobulin(β_(2)-M G),lactate dehydrogenase(LDH),albumin(ALB),creatinine(CRE) and hemoglobin(HGB) levels,and the relationship between T lymphocyte subsets and the above indexes and their clinical significance were analyzed.Results: The proportions of NK cells and CD8^(+)T lymphocytes in the peripheral blood of M M patients were significantly higher than that of the control group(P<0.01),the proportion of CD4^(+)T and the ratio of CD4^(+)/CD8^(+)were lower than those of the control group(P<0.05);however,there was no significant difference in the numbers CD3^(+)T cells compared with the control group(P>0.05).The proportion of CD4^(+)T and ratios of CD4^(+)/CD8^(+)in M M patients were lower than those of normal controls,and were negatively correlated with M M staging(r =-0.964,r =-0.653),that is,the later the M M staging,the more obvious their levels were reduced,while CD8^(+)T and NK cells were positively correlated with M M staging(r=0.891,r=0.728),that is,the later the M M staging,the more significant their levels increased.The levels of Treg cells(CD4^(+)CD25^(high)CD127^(low/-)T cells/CD4^(+)T cells) of M M patients in the disease stage Ⅰ,Ⅱ and Ⅲ were(5.87 ± 0.92) %,(7.97 ± 1.32) %,(11.52 ± 4.71) %respect

关 键 词:多发性骨髓瘤 T淋巴细胞 细胞因子 病情监测 预后 

分 类 号:R733.3[医药卫生—肿瘤]

 

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