摘要
目的 初步探讨免疫相关性全血细胞减少（IRP）患者外周血记忆B淋巴细胞（Bm）亚群的临床意义.方法 以86例IRP患者和11名健康志愿者为研究对象,采用流式细胞术检测外周血Bm水平[CD5＋CD19＋CD27＋细胞比率]、骨髓单个核细胞膜抗体类型,分析其与临床疗效的关系.结果①52例初治患者均接受常规免疫抑制治疗（43例明显显效）.34例复发患者中16例接受利妥昔单抗（RTX）治疗（14例明显显效）,18例接受常规免疫抑制治疗（13例明显显效）.②外周血Bm水平比较：复发组患者水平[（23.00±7.04）％]显著高于初治组[（1.81±0.97）％]及正常对照组[（1.75±0.55）％]（P值均＜0.05）,初治组与正常对照组差异无统计学意义（P＞0.05）;RTX治疗组和常规免疫抑制剂治疗组患者治疗前Bm水平比较,两组差异无统计学意义（P＞0.05）;治疗明显显效后,RTX治疗组Bm水平[（0.22±0.21）％]显著低于常规免疫抑制治疗组[（22.30±10.09）％]（P＜0.05）.复发组患者经RTX治疗后,有效组和无效组患者Bm水平较治疗前均显著减低,但两组差异无统计学意义（P＞0.05）.初治组患者治疗显效后复发者初诊时Bm水平[（3.22±0.67）％]较未复发者[（1.20±0.58）％]明显升高（P＜0.05）.③复发患者骨髓单个核细胞膜抗体类型以IgG（82.4％）为主,初治患者以IgM（69.2％）为主.结论外周血Bm可能与IRP患者病情复发有关;Bm对RTX治疗敏感.
Objective To detect memory B lymphocyte （Bm） in peripheral blood （PB） of immune-related pancytopenia （IRP）.Methods 86 patients with IRP and 11 health volunteers were enrolled in this study.Bm （CD5 ＋ CD19 ＋ CD27 ＋） and bone marrow mononucleated cell antibodies （BMMNC-Ab） were determined via fluorescence-activated cell sorting,and clinical outcomes of these patients were analyzed.Results ①43 initial patients achieved obvious remission in all 52 initial cases after conventional immunosuppression therapy.16 relapsed patients with IRP received Rituximab （RTX） and 14 cases achieved obvious remission,among which 7 cases were refractory to conventional immunosuppression therapy,5 cases exhibited obvious remission,and 2 cases did not respond.Other 18 relapsed cases received conventional immunosuppression therapy and 13 cases achieved obvious remission.①The level of Bm in PB in 52 initial patients with IRP was （1.81±0.97）％,and no significant difference was observed between the initial patients and health volunteers （1.75±0.55）％ （P＞0.05）.The level of Bm in PB in 34 relapsed patients with IRP was obviously higher than that in the initial IRP patients and health volunteers （P＜0.05）.Significant difference was observed in the level of Bm in PB in 16 relapsed IRP patients between pre-therapy and post-therapy with RTX （P＜0.05）.No statistical difference was found between the remission and no-response groups in relapsed patients treated with RTX.RTX regimen produced more effective outcome than conventional immunosuppression therapy,which better eliminated Bm than the latter （P＜0.05）.Initial patients with IRP who relapsed within a two-year follow-up period had a lower level of Bm in PB compared with unrelapsed patients （P＜0.05）.Majority of BMMNC-Ab antibodies in relapsed patients were IgG （82.4％） and IgM （69.2％） autoantibodies in patients with initial IRP.Conclusions The level of Bm in PB was associated with relapsed patients with IRP.Bm did no
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2014年第8期719-723,共5页
Chinese Journal of Hematology
基金
国家自然科学基金（81170472、81370607）
天津市自然科学基金重点项目（12JCZDJC21500）
天津市抗癌重大专项攻关计划（12ZCDZSY17900、12ZCDZSY18000）
天津市卫生行业重点攻关项目（11KG135）
卫生公益性行业科研专项（201202017）
天津市卫生局科技基金（2010KZ105）
天津医科大学科学基金（2010ky20）
