活化T细胞及淋巴细胞亚群在MDS中的分布及意义  

The Distribution and Significance of Activated T Cells and Lymphocyte Subsets in Myelodysplastic Syndrome

作　　者：胡忠利[1] 杨艳丽[1] 张平平 潘少君 HU Zhong-Li;YANG Yan-Li;ZHANG Ping-Ping;PAN Shao-Jun(Department of Hematology,The First Affilicated Hospital of Bengbu Medical College,Bengbu 233000,Anhui Province,China;School of Translational Medicine,Shanghai Jiaotong University,Shanghai 201100,China)

机构地区：[1]蚌埠医学院第一附属医院血液科,安徽蚌埠233000 [2]上海交通大学科转化医学院,上海201100

出　　处：《中国实验血液学杂志》2023年第2期469-475,共7页Journal of Experimental Hematology

基　　金：国家重点研发计划项目(2017YFA0205300)。

摘　　要：目的:探讨骨髓增生异常综合征(MDS)患者骨髓淋巴细胞亚群的分布及免疫表型为CD3^(+)HLA-DR+的活化T细胞在淋巴细胞中的占比及其临床意义,了解不同类型的MDS及不同免疫表型、不同WT1的表达量对淋巴细胞亚群及活化T细胞比例的影响。方法:采用流式细胞术检测96例MDS的免疫表型,以及骨髓淋巴细胞亚群的分布和活化T细胞的表达。采用实时荧光定量PCR检测WT1的相对表达量,统计初次诱导缓解率(CR1)。分析MDS患者不同免疫表型、不同WT1表达量、不同病程情况中淋巴细胞亚群及活化T细胞比例的差异。结果:在MDS-EB-2、IPSS高危、CD34^(+)细胞比例>10%,以及伴有CD34^(+)CD7^(+)细胞群、初诊时WT1基因高表达的MDS患者CD4^(+)T比例明显下降(P<0.05),NK细胞及活化T细胞比例明显升高(P<0.05),但B淋巴细胞比例无明显差异。与正常对照组相比,IPSS中危-2组NK细胞及活化T细胞比例明显升高(P<0.05),但CD3^(+)及CD4^(+)的T淋巴细胞比例无明显差异。与未完全缓解的患者相比,首次化疗后完全缓解的患者CD4^(+)T细胞比例明显升高(P<0.05),NK细胞比例及活化T细胞比例明显减低(P<0.05)。结论:MDS患者中CD3^(+)T淋巴细胞比例减低、CD4^(+)T淋巴细胞比例减低,活化T细胞比例升高提示MDS分化类型更原始,预后更差。Objective:To investigate the distribution of bone marrow lymphocyte subsets in patients with myelodysplastic syndrome(MDS),the proportion of activated T cells with immunophenotype CD3^(+)HLA-DR+in the lymphocytes and its clinical significance,and to understand the effects of different types of MDS,different immunophenotypes,and different expression levels of WT1 on the proportion of lymphocyte subsets and activated T cells.Methods:The immunophenotypes of 96 MDS patients,the subsets of bone marrow lymphocytes and activated T cells were detected by flow cytometry.The relative expression of WT1 was detected by real-time fluorescent quantitative PCR,and the first induced remission rate(CR1)was calculated,the differences of lymphocyte subsets and activated T cells in MDS patients with different immunophenotype,different WT1 expression,and different course of disease were analyzed.Results:The percentage of CD4^(+)T lymphocyte in MDS-EB-2,IPSS high-risk,CD34^(+)cells>10%,and patients with CD34^(+)CD7^(+)cell population and WT1 gene overexpression at intial diagnosis decreased significantly(P<0.05),and the percentage of NK cells and activated T cells increased significantly(P<0.05),but there was no significant difference in the ratio of B lymphocytes.Compared with the normal control group,the percentage of NK cells and activated T cells in IPSS-intermediate-2 group was significantly higher(P<0.05),but there was no significant difference in the percentage of CD3^(+)T,CD4^(+)T lymphocytes.The percentage of CD4^(+)T cells in patients with complete remission after the first chemotherapy was significantly higher than in patients with incomplete remission(P<0.05),and the percentage of NK cells and activated T cells was significantly lower than that in patients with incomplete remission(P<0.05).Conclusion:In MDS patients,the proportion of CD3^(+)T and CD4^(+)T lymphocytes decreased,and the proportion of activated T cells increased,indicating that the differentiation type of MDS is more primitive and the prognosis is worse.

关 键 词：骨髓增生异常综合征 淋巴细胞亚群 活化T细胞 WT1 

分 类 号：R551.3[医药卫生—血液循环系统疾病]