摘要
目的了解骨髓单个核细胞Coombs试验阳性血细胞减少（CBCPC）患者补体水平的变化，探讨补体在CBCPC患者骨髓造血细胞破坏机制中的作用。方法对124例CBCPC患者采用ELISA法测定其骨髓上清中的补体膜攻击复合物（C5b-9）、总补体溶血活性（CH50）以及补体C3、C4水平，并采用流式细胞术（FCM）检测CBCPC患者骨髓单个核细胞膜自身抗体结合率，测定23名正常人的骨髓液补体水平；并同时测定其中30例CBCPC患者和7名正常人的外周血血清补体水平。结果CBCPC初治组骨髓C5b-9水平[（119．8±54．0）μg/L]高于恢复组[（100．7±33．4）μg／L]和正常对照组[（93．9±28．8）μg／L]（P〈0．05）；初治组、恢复组骨髓CH50水平[（33．3±11．5）kU／L，（30．8±10．3）kU／L]高于正常对照组[（24．1±6．4）kU／L]（P〈0．05）；初治组、恢复组骨髓C3水平[（4．9±2．2）mg／L、（5．0±3．5）mg／L]低于正常对照组[（7．0±5．6）mg／L]（P〈0．05）；外周血血清补体水平检测结果与骨髓检测结果一致。CBCPC患者骨髓CH50与C3水平呈负相关（r=-0．303，P=0．007）；CH50与C5b-9水平呈正相关（r=0．241，P=0．003）。骨髓细胞膜IgM阳性的CBCPC组C5b-9水平[（117．6±55．7）μg/L]高于IgM阴性组[（99．2±26．2）μg/L]（P〈0．05），骨髓CD34^＋细胞膜IgG结合率、CD34^＋细胞膜IgM结合率与C5b-9呈正相关（r=0．593，P=0．000；r=0．326，P=0．049），CH50水平与网织红细胞呈正相关（r=0．421，P=0．000），与间接胆红素亦呈正相关（r=0．230，P=0．032）。结论CBCPC患者外周血细胞减少与骨髓单个核细胞自身抗体激活补体破坏造血细胞有关。
Objective To investigate the variation of bone marrow complement level in eytopenia patients with positive BMMNC-Coombs test（CBCPC）, and probe the role of complement in destroying hematopoietic cells of CBCPC patients. Methods One hundred and twenty-four patients with CBCPC and twenty- three healthy donors as controls were enrolled in this study. The levels of CH50, C3, C4, C5b-9 were tested with ELISA. The auto-antibodies on bone marrow hematopoietic cells （BMHC） were examined with flow eytometry. Results The level of C5b-9 in bone marrow（BM） of untreated CBCPC patients [ （119.8 ± 54.0） μg/L] was significantly higher than that of recovered patients [ （ 100.7±33.4 ） μg/L] or normal controls [ （93.9 ±28.8） μg/L] （ P 〈 0.05 ）. The levels of CH50 in BM of untreated or recovered CBCPC patients [ （ 33.3 ± 11.5 ） kU/L, （ 30.8 ±10.3 ） kU/L] were significantly higher than that of normal controls [ （ 24.1 ± 6.4） kU/L ] （ P 〈 0.05 ）. The level of C3 in BM of untreated or recovered CBCPC patients [ （4.9 ±2.2 ） mg/ L], （5.0 ± 3.5 ） mg/L ] was significantly lower than that of normal controls [ （ 7.0 ± 5.6 ） mg/L ] （ P 〈 0.05 ）. The level of complement in peripheral blood was consistent with that in BM. CH50 in BM of CBCPC patients was negatively correlated with their C3 （r = -0. 303,P = 0. 007 ） and positively correlated with their C5b-9（r = 0. 241, P = 0. 003） levels. The level of C5b-9 in BM of CBCPC patients was higher in the BMHC-IgM positive group [ （ 117.6 ± 55.7） μg/L] than in the BMHC- IgM negative group [ （99.2 ± 26.2） μg/L] （ P 〈 0.05 ）. The positive rate of CD34^＋ -IgG or CD34^＋ -IgM of CBCPC patients was positively correlated with their C5b-9 level（ r = 0. 593, P = 0. 000, r = 0. 326, P = 0.049）. The reticulocyte percentage （ r = 0. 421, P = 0. 000） and serum indirect bilirubin level （r = 0. 230, P = 0. 032） of CBCPC patients were positively correlated with their CH50 level. Conclusions The hematocytopenia of CBCPC patients might be related to the hematopoietic cells destruction caused by auto-antibody activated complements.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2009年第7期454-457,共4页
Chinese Journal of Hematology
基金
基金项目：国家自然科学基金（30670886、30470749）
天津市高等学校科研基金（200317）
天津市卫生局科技基金项目（03KZ26）
国家“十一五”科技支撑项目（2008BAI61B00）
高等学校博士学科点专项科研基金（200800620004）
天津市科技支撑计划重点项目（07ZCGYSF00600）
天津市应用基础及前沿技术研究计划（08JCYBJC07800）
