摘要
目的:观察风湿免疫相关性血细胞减少(Rheumatism immune-related hematocytopenia,RIRH)患者骨髓免疫细胞炎性因子分泌状态,探讨其对骨髓造血细胞损伤的病理作用及临床意义。方法:①ELISA法检测66例RIRH患者血清IL-5、IL-10、IL-12、IL-17和IFN-γ浓度,对照组30例采自健康查体血清;免疫化学法观察骨髓免疫细胞HLA-DR表达;②免疫荧光法观察骨髓细胞抗人球蛋白(IgG)抗体、FcγⅡ受体(FcγⅡR)、甘露糖受体(MR)、ICAM-1、IL-12、IL-17A与IL-17RA表达;30例缺铁性贫血患者骨髓作为疾病对照;③随机抽取32例血小板>50×109L-1无出血倾向患者,常规治疗同时联合复方丹参促进炎性因子代谢,与30例不联合复方丹参患者对照治疗效果。结果:①66例患者血清IL-5、IL-10、IL-12、IL-17和IFN-γ浓度分别为(126.04±7.66)ng/L,(316.23±25.163)ng/L,(328.43±27.01)ng/L,(48.17±4.22)ng/L和(40.28±3.69)ng/L,较之对照组(33.16±2.17)ng/L,(176.25±10.69)ng/L,(94.05±3.26)ng/L,(20.03±1.14)ng/L和(8.25±2.01)ng/L显著升高;②骨髓中活化的组织嗜碱细胞、嗜酸性粒细胞(EOS)、树突状细胞和巨噬细胞(Mφ)等免疫细胞高表达HLA-DR、FcγⅡR、MR、ICAM-1、IL-12、IL-17A和IL-17RA;③32例IRHS患者联合复方丹参组经治疗2周后,血清IL-5和IL-17含量较之对照组显著降低,血象恢复时间较之对照组提前1周。结论:RIRH患者骨髓中多种免疫细胞活化,表达和分泌多种免疫分子,介导ADCC效应、细胞免疫功能和炎性反应,是损伤病变的造血细胞的重要免疫机制。抗感染、抑制免疫联合复方丹参活血化瘀,能改善骨髓造血微环境,促进造血恢复。
Objective ： To observe expression of the inflammatory molecules on bone marrow immunocytes of patients with rheu- matism immune-related hematocytopenia （RIRH）, and to investigate the pathomeehanism as well as clinical significance of marrow hematopoietic cellular injury induced by those inflammatory factors. Methods：（1）ELISA was performed to detect serumal concentrations of cytokines IL-5, IL-10, IL-12, IL-17 and IFN-γ/from 66 RIRH patients. 30 samples from healthy people were selected as control. Immunochemistry was used for detecting the expression state of HLA-DR were analysed. （2）Immune fluorescence （IF） was performed to observed the expression of anti-human globulin （IgG） immunoglobulin, Fc γII receptor （Fcγ/11 R） , mannan receptor （MR） , ICAM- 1, IL-12, IL-17A and IL-17RA on marrow cells. Marrow from 30 iron deficiency anemia patients were selected as disease control.（3） 32 patients whose platelets 〉 50 × 109 L^- 1 and without hemorrhagic tendency were selected and given compound recipe Salvia mihiorrhi- za associated with conventional therapy, then the treatment effectiveness was evaluated compared with 30 patients only receiving con- ventional therapy. Results：（1）Serumal IL-5, IL-10, IL-12, IL-17 and IFN-γelevated in varying degrees in 66 patients, the results were respectively （126.04 ±7.66） ng/ml, （316.23 ±25. 163） ng/ml, （328.43 ±27.01） ng/ml, （48.17 ±4.22） ng/ml and （40.28 ± 3.69） ng/ml, compared with the control group [ （33.16 ± 2.17） ng/L, （ 176.25 ± 10.69） ng/L, （94.05 ± 3.26） ng/L, （20.03 ± 1.14） ng/L and （8.25 ±2.01） ng/L）], the result were increased obviously. （2）HLA-DR,Fcγ lI R, MR, ICAM-1, IL-12, IL-17A and IL-17RA were in high level on immunocyte and destruction to hematopoietic cell induced by ADCC and cellular immunity could be observed. （3）After two weeks of treatement with compound recipe Salvia, seminal IL-5 and IL-17 of 32 RIRH patients decreased obvi- ously, and the recovery to normal of bemogram advanced about one week. Conclusion： The immunoeyte were activated and would expres：s or secrete immunity molecules inducing ADCC and inflammatory reaction to destroy target cells. Routine therapy associated with Salvia miltiorrhiza could activate blood circulation to dissipate blood stasis and remove inflammatory factors as well as promote the re- covery of bone marrow hemopoiesis.
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2013年第1期52-56,73,共6页
Chinese Journal of Immunology
基金
济南军区"十二五"重点支持项目(JN11L-017)
