免疫相关全血细胞减少患者骨髓造血祖细胞增殖功能及辅助性T淋巴细胞功能观察  

Proliferation of bone marrow hematopoietic stem cells and function of T helper lymphocytes of patients with immuno-related pancytopenia

作　　者：付蓉[1,2] 邵宗鸿[1] 刘鸿[1] 和虹[1] 孙娟[1] 赵明峰[1] 何广胜[1] 施均[1] 白洁[1] 杨天楹[1] 杨崇礼[1] 

机构地区：[1]中国医学科学院,中国协和医科大学血液学研究所,血液病医院,天津300020 [2]天津医科大学总医院血液肿瘤科,300052

出　　处：《中华血液学杂志》2004年第4期213-216,共4页Chinese Journal of Hematology

基　　金：卫生部临床学科重点基金资助项目 ( 0 0 7);卫生部基金资助项目 ( 96 2 10 7)

摘　　要：目的　了解与免疫相关全血细胞减少患者骨髓造血祖细胞增殖分化功能以及辅助性T(Th)淋巴细胞在此类患者发病中的作用。方法　采用甲基纤维素法培养 2 5例初诊、15例治疗后血常规恢复的免疫相关全血细胞减少患者和 10名正常人的CFU GM、CFU E、BFU E ;采用RT PCR方法 ,检测 2 5例初诊、15例治疗后血常规恢复的免疫相关全血细胞减少患者、19例其他全血细胞减少症患者和 10名正常人未经体外刺激的骨髓单个核细胞 (BMMNC)中Th1细胞的代表因子IFN γ、IL 2和Th2细胞的代表因子IL 4、IL 10的基因表达。结果　初诊组、治疗后血常规恢复正常的免疫相关全血细胞减少患者组、正常对照组BMMNC培养CFU E、CFU GM、BFU E产率 ,三组差异均无显著性 (P均 >0 .0 5 ) ,Th2型细胞因子IL 4、IL 10mRNA的表达在初诊组明显增高 ,与正常对照组比较 ,P均 <0 .0 1;经治疗血常规恢复正常后趋于正常 ,与正常对照组比较 ,P均 >0 .0 5。Th1型细胞因子IFN γ、IL 2mRNA的表达在所有免疫相关全血细胞减少患者均无增高 ,与正常对照组比较 ,P均 >0 .0 5。结论　引起免疫相关全血细胞减少患者全血细胞减少的原因可能并非骨髓造血祖细胞本身质的异常 ,而是造血祖细胞以外的因素 ;Th细胞亚群功能失衡。Objectives To explore the proliferative capacity of bone marrow hematopoietic stem cells and the function of T helper (Th) lymphocytes of patients with immuno-related pancytopenia(IRP). Methods Twenty-five untreated IRP patients,15 IRP patients in complete remission(CR) and 10 normal controls were studied for in vitro yields of CFU-GM,CFU-E and BFU-E from bone marrow mononuclear cells(BMMNC). The mRNA expressions of IL-4, IL-10, IFN-γ and IL-2 genes in unstimulated BMMNC from 25 untreated IRP patients,15 IRP patients in CR, 19 patients with other hematological diseases presenting pancytopenia and 10 normal controls were detected by reverse transcription polymerase chain reaction (RT-PCR). Results There was no significant difference of the yields of CFU-E, CFU-GM or BFU-E among the untreated, and in CR IRP patients and normal controls(P>0.05). The mRNA expressions of IL-4 and IL-10 of Th2 cells were significantly higher in untreated IRP patients than in the other groups. The mRNA expressions of IFN-γ and IL-2 of the Th1 cells in all IRP patients were not higher than those in the other groups. Conclusions The cytopenia of IRP patients was not caused by the qualitative abnormality of the hematopoietic stem cells but by the destruction or suppression of hematopoietic stem cells from certain extrinsic insults. The imbalance of Th lymphocytes subtypes and overfunction of Th2 lymphocytes played important roles in the pathogenetic mechanism of IRP leading to increased and overfunctional B lymphocytes, which produced autoantibodies destructing or suppressing hematopoiesis in IRP.

关 键 词：免疫相关全血细胞减少 骨髓造血祖细胞 细胞增殖 T淋巴细胞 甲基纤维素法 

分 类 号：R55[医药卫生—血液循环系统疾病]