摘要
目的探讨骨髓单个核细胞Coombs（BMMNC—Coombs）试验阳性血细胞减少（又称免疫相关性血细胞减少，IRP）患者骨髓巨噬细胞（Mm）活化抗原表达及其临床意义。方法采用流式细胞仪（FACS）检测61例IRP患者及10例重型再生障碍性贫血（SAA）（病例对照组）和13例正常人（正常对照组）骨髓造血细胞膜自身抗体类型、骨髓M①数量（CD未／CD未）％及Mm活化抗原（CD^69）表达水平（CD68^＋CD69^＋／CD68^＋）％，并探讨其临床意义。结果61例IRP患者其Mm数量及活化抗原表达水平[（0．57±0．30）％和（40．30±18．49）％]均高于病例对照组[（0．46±0．08）％和（32．44±19．37）％]及正常对照组[（0．44±0．69）％和（29．71±11．67）％]（P值均〈0．05）；且其M中数量与活化抗原表达水平呈明显正相关（r=0．89，P〈0．01）。根据Mm数量分为A组（MФ百分率≥0．5％）和B组（Mm百分率〈0．5％），A组34例患者中32例（94．1％）有自身抗体IgG，B组27例患者中仅2例（7．4％）；A组患者骨髓Mm活化抗原表达水平（49．19±16．63）％显著高于B组患者（29．H±14．30）％（P〈0．05），而B组患者和病例对照组及正常组无统计学意义（P值均〉0．05）；A组患者的3、6个月的总有效率（分别为47．06％、79．41％）均明显优于B组患者同期的疗效（22．22％、51．85％）（P〈0．05）；并且A、B组患者6个月的总有效率（79．41％、51．85％）均明显高于3个月的疗效（47．06％、22．22％）（P值均〈0．05）。34例自身抗体IgG（＋）IRP患者按M中数量分为高（≥0．75％）、低（〈0．75％）水平2组，25例M中低水平组24例仅能检测到1系骨髓细胞（CD34^＋或CD15^＋或GlycoA^＋）有自身抗体IgG（96％），1例检测到2系骨髓细胞有自身抗体IgG；9例Mm高水平组有8例能检测到2系骨髓细胞有自身抗体IgG，1例为3系骨髓细胞均有自身抗体IgG；高水平组IRP患者M巾活化抗原表达水平（56．12±15．11）％显著高于低水平组（44．58±18．16）％（P〈0．05）；外周血红细胞、血红蛋白、血小板计数均显著低于低水平组（P〈0．05）；而外周血网织红细胞比例、总胆红素、间接胆红素及胸骨红系比例均显著高于低水平组（P〈0．05）。结论IRP患者（尤其有骨髓造血细胞膜自身抗体IgG的IRP患者）骨髓M垂数量明显增多，活化抗原高表达，即多呈激活状态，激活的巨噬细胞可能参与IRP患者骨髓早期造血细胞的破坏。
Objective To explore the expression of antigen activated of macrophages （MФ） of bone marrow and its clinical significance in pancytopenia patients with positive bone marrow mononuclear cells （BMMNC）-Coombs test （immunorelated pancytopenia, IRP）. Methods Sixty-one IRP patients, 10 severe aplastic anemia （SAA） patients and 13 healthy controls were enrolled in this study. The categories of auto-antibodies（ lgG, IgM） on BMMNC（ CD34^＋/CD15^＋/GlycoA^＋ hematocytes）, the quantity （ CD68^＋/CD45^＋） % and expression of antigen activated （ CD69 ） of MФ （ CD68^＋ CD69^＋/CD68^＋ ） % in bone marrow of all cases and controls were measured by fluorescence activated cell sorting（FACS）. Results The quantity and expression ratio of activated antigen of bone marrow （ BM ） MФ in IRP patients [ （ 0. 57 ＋ 0. 30 ） % and （ 40. 30 ± 18.49）% ] were respectively significantly higher than those in SAA [ （0.46±0. 08）% and （32. 44 ± 19.37）%] and healthy controls [（0.44 ±0.69）% and （29.71 ±11.67）%] （both P 〈0.05）. The quantity presented high-positive correlation with the expression ratio of activated antigen of BM MФ （ r = 0. 89, P 〈 0. 01 ）. Patients with IRP were classified into two subgroups according to the quantity of MФ： Group A （MФ≥0. 5%, 34 cases） and Group B （MФ≤ 0. 5%, 27 cases）. Thirty-two cases （94. 12% ） were with auto antibody （IgG） in Group A, while only 2 （7.41%） with auto antibody （IgG） in Group B. There was significant difference in expression ratio of activated antigen of BM MФ between Group A （49. 19 ± 16. 63 ） % and Group B （ 29. 11 ± 14. 30 ） % （ P 〈 0. 05 ）, but no difference was found between Group B and the control group （ P 〉0. 05）. Total curative rates at 3 and 6 month （47.06% and 79.41% ） of Group A were better than those of Group B （22.22% and 51.85% ）. Thirty-four IRP patients with autoantibody （IgG） （ ＋ ） were divided into two subgroups according to the quantity of MФ ： high level group （ ≥0. 75% , 9 cases） and low level group（ 〈0. 75% , 25 cases） , 24 cases （96%） in MФ low level group were found auto-antibody （IgG） on one hemotopoietic cell lineage, 1 on two lineages, while 8 （88.89%） in MФ high level group were detected auto-antibody （IgG） on two cell lineages, and 1 on three cell lineages. Expression ratio of activated antigen （56. 12 ± 15.11 ）% was much higher in MФ high level group than that in MФ low level group （44. 58 ± 18. 16）% （P 〈 0. 05 ）. The count of red blood cell concentration of hemoglobin and platelet in peripheral blood in MФ high level group were respectively lower than those in MoP low level group, while the percentage of Ret, the level of total bilirubin and indirect bilirubin, the ratio of erythroid of sternal bone marrow in MФ high level group were higher than those in MФ low level group. Conclusion The expression of activated antigen of BM MФ was enhanced in IRP especially with autoantibody （IgG） , which might be involved in damage process of hemotopoietic cell.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第2期146-149,共4页
Chinese Journal of Internal Medicine
基金
国家自然科学基金（30670886,30470749）
国家“十一五”科技支撑项目（2008BAI61BOO）
高等学校博士学科点专项科研基金（200800620004）
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）
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）
