骨髓增生异常综合征患者淋巴细胞精细分型特征  

Characteristics of fine lymphocyte typing in myelodysplastic syndrome

作　　者：时雨 王敏[1] 张宁涵 刘芳[1] 乔纯[1] 王琰[1] 王蓉[1] 金惠敏 吴雨洁[1] Shi Yu;Wang Min;Zhang Ninghan;Liu Fang;Qiao Chun;Wang Yan;Wang Rong;Jin Huimin;Wu Yujie(Department of Hematology,the First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)血液科,南京210029

出　　处：《中华检验医学杂志》2024年第12期1403-1410,共8页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(82370195);江苏省自然科学基金(BK20231367)。

摘　　要：目的探讨骨髓增生异常综合征(MDS)患者淋巴细胞精细分型的特征, 以评估MDS患者病程中免疫状态变化。方法回顾性研究南京医科大学第一附属医院2022年2月1日至2024年1月31日确诊的73例MDS患者, 包括男47例, 女26例, 年龄66(56, 73)岁, 以同期健康管理中心30名健康人作为对照组, 采用流式细胞术对其进行淋巴细胞精细分型检测。比较各组间淋巴细胞亚群分布差异;采用Spearman秩相关系数分析淋巴细胞亚群与原始细胞或CD34^(+)细胞相关性。结果随着修订的国际预后评分系统(IPSS-R)危险程度升高, 较低危组、中危组、较高危组辅助性T(Th)细胞(P=0.047)及纯真亚群(CD4^(+)CD45RA^(+)CD62L^(+))比例(P=0.021)逐渐升高, 记忆亚群(CD4^(+)CD45RA^(-))比例逐渐降低(P=0.007);与基因突变数目较低组相比, 较高组B细胞(8.76%比18.41%, P=0.005)及杀伤性T细胞活晚期化亚群(CD8^(+)HLADR^(+))比例(21.21%比31.69%, P=0.020)较低;自然杀伤(NK)细胞比例较高(14.98%比8.94%, P=0.032)。原始细胞与Th细胞(P=0.022)、CD4^(+)CD45RA^(+)CD62L^(+)T细胞(P=0.045)、CD4^(+)CD45RA^(-)T细胞(P=0.017)及杀伤性T细胞高度活化亚群(CD8^(+)CD38^(+)HLADR^(+))比例(P=0.013)存在相关性。结论 MDS患者Th细胞及纯真亚群比例升高, 记忆亚群比例降低可能预示IPSS-R危险度升高;B细胞及CD8^(+)HLADR^(+)T细胞比例降低, NK细胞比例升高可能提示基因突变的累积。不同IPSS-R危险度、不同基因突变数目的MDS患者淋巴细胞亚群分布差异提示在MDS患者病程中存在免疫失调, 淋巴细胞精细分型有助于评估MDS患者免疫功能变化。Objective:To investigate the characteristics of fine lymphocyte typing in patients with myelodysplastic sydrome(MDS)and evaluate the changes of immune status during the course of MDS.Methods:A retrospective study was conducted on 73 patients with MDS,including 47 males and 26 females,aged 66(56,73)years old,diagnosed at the First Affiliated Hospital of Nanjing Medical University from February 1,2022 to January 31,2024.Besides,30 healthy individuals from the Health Management Center were selected as the control group.The deep lymphocyte typing was detected by flow cytometry.The differences of lymphocyte subset distribution among the groups were compared;Spearman′s rank correlation coefficient was used to analyze the correlation between lymphocyte subpopulation and blast cells or CD34^(+)cells.Results:As the risk level of revised International Prognostic Scoring System(IPSS-R)increased,the proportion of helper T(Th)cells(P=0.047)and naivesubpopulation(CD4^(+)CD45RA^(+)CD62L^(+))(P=0.021)in the low-risk group,middle-risk group,and high-risk group increased gradually,while memory subpopulation(CD4^(+)CD45RA^(-))(P=0.007)gradually decreased;compared to the group with the low amount of gene mutations,the proportion of B lymphocyte cells(8.76%vs 18.41%,P=0.005)and late activated cytotoxic T lymphocyte(Tc)cells(CD8^(+)HLADR^(+))(21.21%vs 31.69%,P=0.020)decreased in the high group,and natural killer(NK)cells increased(14.98%vs 8.94%,P=0.032).There was a correlation between the percentage of blast cells and the proportion of Th cells(P=0.022),naive subpopulation(P=0.045),memory subpopulation(P=0.017),and highly activated Tc cells(CD8^(+)CD38^(+)HLADR^(+))(P=0.013).Conclusions:In patients with MDS,the proportion of Th cells and naive subpopulations is increased,while that of memory subpopulations is decreased,which may indicate an increased risk of IPSS-R;the decreased proportion of B cells,late activated Tc cells,and the increased proportion of NK cells may suggest the accumulation of gene mutations.The differences of ly

关 键 词：骨髓增生异常综合征 淋巴细胞精细分型 免疫失调 IPSS-R 基因突变 

分 类 号：R551.3[医药卫生—血液循环系统疾病]