摘要
目的探讨重症肌无力（MG）患者外周血CD4^＋CD25^＋调节性T（Treg）细胞数量与血清抗乙酰胆碱受体抗体（AChR—Ab）和转化生长因子（TGF）-β1含量的相关性。方法前瞻性地纳入40例新近发病或加重的MG住院患者和38名年龄、性别匹配的健康对照，应用流式细胞仪检测外周血CD4^＋CD25^＋Treg细胞数量，酶联免疫法检测血清TGF-β1含量，放免法检测血清AChR-Ab滴度，并对三者进行了相关性分析。结果MG患者外周血CD4^＋CD25^＋Treg细胞百分率（3．0％±2．5％）显著低于健康对照（4．6％±3．7％，P=0．03）。发病晚、病程长、抗AChR-Ab阳性、胸腺正常或退化以及未接受胸腺切除治疗等因素与MG患者CD4^＋CD25^＋Treg细胞减低有关。在31例非胸腺瘤MG（non-MGT）患者中，血清TGF-β1含量（112ng／L±83ng／L）显著低于健康对照（215ng／L±134ng／L，P=0．00），但在MG各临床亚型之间差异无统计学意义。虽然MG患者CD4^＋CD25^＋Treg细胞百分率与血清AChR—Ab滴度不呈线性相关，但在非MGT患者中二者呈负相关（r=-0．37，P=0．02）。非MGT患者血清AChR—Ab滴度还与Osserman临床分型和MGFA评分之间呈正相关（均r=0．34，P=0．03）。非MGT患者血清TGF-β1含量与美国MG协会（MGFA）评分和CD4^＋CD25^＋Treg细胞百分率无相关性。结论MG患者外周血CD4^＋CD25^＋Treg细胞百分率和血清TGF-β1含量均明显低于健康对照，可能参与了MG的发病。非MGT患者中Treg细胞百分率与AChR—Ah滴度呈负相关，检测其水平可能对评估MG病情及治疗提供理论依据，但是应用于临床还需要更多的相关研究。
Objective The purpose of the current study is to demonstrate possible involvement of CD4^＋CD25^＋ Treg cells and TGF-β in immune activation in patients with myasthenia gravis （MG）. If so, how does CD4^＋CD25^＋ Treg cells and TGF-β, collaborate to impact on the production of pathogenic anti- AChR antibodies （Ab）.9 Methods 40 MG in-patients with recent onset or deterioration and age and gender-matched 38 healthy subjects were consecutively enrolled. Flow cytometry was employed to detect circulating CD4^＋CD25^＋ Treg cells. Levels of AChR-Abs and TGF-β1 in serum were detected by radioimmunoassay and enzyme-linked immunoabsorbance assay respectively. Results Numbers of CD4^＋CD25^＋ Treg cells were significantly decreased in MG patients （3. 0% ±2.5% ） compared with healthy controls（4. 6% ±3. 7% ,P =0. 03）. Decreased production of CD4^＋CD25^＋ Treg cells was associated with late-onset, longer-duration, pesitive-MG sera for AChR-Abs, normal or atrophic thymus, and nonthymectomy treatment et al, respectively. Although CD4^＋CD25^＋ Treg ceils were not linear-correlated with serum anti-AChR Ab titers, but were conversely correlated with each other in MG patients without thymoma （non-MGT） （r = -0. 37, P = 0. 02 ）. Likewise, levels of TGF-β1 in 31 non-MGT patients （ 112 ng/L ± 83ng/L） were decreased compared with those of healthy subjects（215 ng/L =1= 134 ng/L,P =0. 00） , and was conversely correlated with titers of anti-AChR Abs （ r = - 0. 37, P = 0. 02）. The titer of anti-AChR Abs were correlated with Osserman classification and MGFA grade （ r = 0. 34, P = 0. 03 ）. Conclusion Numbers of CD4^＋CD25^＋ Treg cells and levels of TGF-β1 in MG patients were significantly decreased compared with healthy controls, and may thus contribute to the pathogenesis of MG. Numbers of CD4^＋CD25^＋ Treg cells were conversely correlated with levels of anti-AChR Abs in non-MGT patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第15期1036-1040,共5页
National Medical Journal of China
