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目的探讨慢性再生障碍性贫血(CAA)发病的免疫因素,为CAA的临床治疗提供依据。方法采用骨髓细胞半固体集落培养法检测粒-单核细胞集落形成单位(GM-CFU),同时用流式细胞仪检测T淋巴细胞亚群。结果CAA骨髓细胞培养GM-CFU产率明显少于正常对照组,(7.9±0.5)个/ml vs(88.7±2.7)个/ml(P<0.01);CAA骨髓细胞加正常血清培养GM-CFU的产率与正常对照组比较差异无统计学意义,(82.4±2.6)个/ml vs(88.7±2.7)个/ml(P<0.05),其中有21例的GM-CFU的产率(60.1±2.1)个/ml与对照相比较明显减少;CAA血清与正常骨髓细胞培养的GM-CFU为(105.6±3.2)个/ml,显著高于正常组。CAA组的CD3+、CD4+和CD4+/CD8+均比对照组降低,分别为(49.8±0.6)%vs(64.3±0.9)%(、29.7±0.4)%vs(38.6±0.3)%和(1.2±0.1)%vs(1.7±0.1)%(均P<0.01);CD8+细胞明显高于正常,(28.9±0.3)%vs(24.5±0.3)%(P<0.01)。结论CAA患者普遍存在着T细胞亚群失衡的免疫异常;CAA患者骨髓细胞中可能有抑制患者GM-CFU形成的因素,而血清中存在着升高的粒-单核细胞集落刺激因子等,其临床意义尚需进一步观察。GM-CFU体外培养联合T细胞亚群检测,可作为CAA异常免疫机制的诊断指标。
Objective To investigate the immunological factors of the pathogenesis of chronic aplastic anemia (CAA) and provide the basis for the clinical treatment of CAA. Methods The granulocyte-mononuclear cell colony forming unit (GM-CFU) was detected by semi-solid colony culture of bone marrow cells and the T lymphocyte subsets were detected by flow cytometry. Results The production of GM-CFU in CAA myeloid cells was significantly lower than that in the normal control group (7.9 ± 0.5) / ml vs (88.7 ± 2.7) / ml (P0.01) .CAA myeloid cells and normal serum were cultured in GM-CFU (82.4 ± 2.6) / ml vs (88.7 ± 2.7) / ml, respectively (P <0.05). The yield of GM-CFU in 21 cases (60.1%) was significantly lower than that in the normal control group ± 2.1) cells / ml. The GM-CFU cultured in CAA serum and normal bone marrow cells was (105.6 ± 3.2) / ml, which was significantly higher than that in normal group. (49.8 ± 0.6)% vs (64.3 ± 0.9)% (29.7 ± 0.4)% vs (38.6 ± 0.3)% vs (1.2 ± 0.1%) in the CAA group compared with the control group ) were significantly higher than those in normal controls (28.9 ± 0.3% vs (24.5 ± 0.3)%, P <0.01). CONCLUSIONS: Unbalanced immune abnormalities of T-cell subsets are common in CAA patients. There may be factors that inhibit the formation of GM-CFU in CAA patients, but there is elevated granulocyte-monocyte colony stimulating factor Clinical significance still needs further observation. GM-CFU combined with T cell subsets detection can be used as a diagnostic indicator of CAA abnormal immune mechanisms.