再生障碍性贫血患者T细胞亚群检测的临床意义.doc

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1、再生障碍性贫血患者T细胞亚群检测的临床意义作者：张强，李庆，徐静玮，张爱梅，徐修才，翟志敏【摘要】本研究探讨再生障碍性贫血(AA)患者外周血T细胞亚群的变化及其与AA发病、免疫抑制治疗之间的关系；为AA患者合理选择治疗方案提供依据。以88例临床确诊为AA、并分别接受常规和常规联合免疫抑制治疗的患者为对象，采用三色免疫荧光抗体标记法和流式细胞术检测外周血T淋巴细胞亚群及CD4+和CD8+比值，参考正常对照组水平将患者分为比值正常型、比值倒置型和比值超高型3个免疫亚型，分析和比较各亚型与病情、疗效之间的关

2、系。结果表明：CD4+/CD8+比值正常型占39.8%、比值倒置型占44.3%、比值超高型占15.9%。免疫亚型、治疗方法与总有效率的关系为：单独常规治疗时，3个亚型组之间疗效无明显差异；当联合免疫抑制治疗时，比值正常型患者的总有效率与常规治疗相比无显著改变，而比值倒置型及免疫异常型(比值倒置型+比值超高型)患者有效率较同组常规治疗疗效均显著提高(84.2%vs45.5%及82.6%vs42.8%，p值均<0.05)，也显著高于比值正常型患者(84.2%及82.6%vs52.6%，p值均<

3、0.05)。结论：大多数AA患者存在严重的CD4+和CD8+比值失调，CD4+/CD8+异常既可表现为降低，也可以是异常增高，AA发病机制与免疫异常有密切相关性；T细胞亚群检测对临床了解病情和发病机制、合理选择治疗方案、提高诊断和治疗水平具有重要价值。【关键词】再生障碍性贫血ClinicalSignificanceofDetectionofTcellSubgroupsinPatientswithAplasticAnemiaAbstractThestudywasaimedtoinvestigateth

4、echangesofTcellsubgroupsintheperipheralblood(PB)ofpatientswithaplasticanemia(AA)andtherelationshipsbetweenthesechangesandthepathogenesisofAAandtheimmunosuppressivetherapeuticeffectsinAA,inordertoprovideabasisforselectingrationaltherapyofAApatients.Tce

5、llsubtypeandtheratioofCD4+/CD8+cellinthePBof88AApatientswhichhadbeendiagnosedclearlyandgivenconventionaltherapyorconventionaltherapycombinedwithimmunotherapywereanalyzedbytricolourfluorescencelabeledmonoclonalantibodyandusingmultiparameterflowcytometr

6、y.ThepatientswithAAweredividedintonormaltypeofratio,invertedtypeofratio,hypernormaltypeofratioaccordingtotheratioofCD4+/CD8+cellinnormalgroup,andthentherelationsofthesesubtypewithpatients'conditionsand6therapeuticeffectswereinvestigated.Theresultsshowed

7、thatthepercentageofnormaltypeofratioinallpatientswas39.8%,thepercentageofinvertedtypeofratioinallpatientswas44.3%,Thepercentageofhypernormaltypeofratioinallpatientswas15.9%.Intheconventionaltherapyalone,therewasnosignificantdifferenceontherapeuticeffect

8、samongthesethreeimmunologicalsubtypes.Incombinedimmunotheray,totaltherapeuticeffecacyofAApatientswithinvertedtypeofratioandAApatientswithimmunologicabnormality(invertedtype+hypernormaltype)was84.2%and82.6%respectively,whichweremo