再生障碍性贫血患者T细胞亚群检测临床意义.docVIP

再生障碍性贫血患者T细胞亚群检测临床意义 　 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% vs 45.5%及82.6% vs 42.8%， p值均lt;0.05)，也显著高于比值正常型患者(84.2%及82.6% vs 52.6%，p值均lt;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 Clinical Significance of Detection of Tcell Subgroups in Patients with Aplastic Anemia Abstract The study was aimed to investigate the changes of Tcell subgroups in the peripheral blood (PB) of patients with aplastic anemia (AA) and the relationships between these changes and the pathogenesis of AA and the immunosuppressive therapeutic effects in AA, in order to provide a basis for selecting rational therapy of AA patients. Tcell subtype and the ratio of CD4+/CD8+ cell in the PB of 88 AA patients which had been diagnosed clearly and given conventional therapy or conventional therapy combined with immunotherapy were analyzed by tricolour fluorescence labeled monoclonal antibody and using multiparameter flow cytometry. The patients with AA were divided into normal type of ratio, inverted type of ratio, hypernormal type of ratio according to the ratio of CD4+/CD8+ cell in normal group, and then the relations of these subtype with patients’ conditions and therapeutic effects were investigated. The results showed that the percentage of normal type of ratio in all patients was 39.8%, the percentage of inverted type of ratio in all patients was 44.3%, The percentage of hypernormal type of ratio in all patients was 15.9%. In the conventional therapy alone, there was no significant difference on therapeutic effects