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目的探讨CD4+T细胞亚群(Th1、Th2、Th17及Treg细胞)在再生障碍性贫血(AA)、骨髓增生异常综合征(MDS)、急性髓系白血病(AML)患者免疫发病机制中的作用,为临床治疗提供实验依据。方法采用流式细胞术检测AA组25例,MDS组48例[其中难治性贫血(MDS-RA)22例,难治性贫血伴原始细胞增多(MDS-RAEB)26例],AML组12例和正常对照组8例的外周血单个核细胞Th1、Th2、Th17及Treg细胞比例并对比分析,评价各组的细胞免疫状态。结果与正常对照组相比,AA组Th1、Th17细胞及Th1/Th2升高,而Th2和Treg细胞比例减低(P<0.05);MDS组Th1、Th2细胞、Th1/Th2与正常对照组比较差异均无统计学意义(P>0.05),而Th17和Treg细胞比例升高(P<0.05);MDS-RA组Th1、Th17细胞比例和Th1/Th2均升高(P<0.05),Th2细胞比例减低(P<0.05),而Treg细胞比例差异无统计学意义(P>0.05);MDS-RAEB组和AML组Th1、Th17细胞比例和Th1/Th2减低(P<0.05),Th2和Treg细胞比例升高(P<0.05)。结论 AA、MDS不同阶段与AML患者的细胞免疫状态不同,在AA和MDS早期阶段,免疫因素介导的凋亡过度是骨髓衰竭的主要原因;而在MDS晚期和AML阶段,异常克隆细胞的大量积聚可能是其主要原因。
Objective To investigate the role of CD4 + T cell subsets (Th1, Th2, Th17 and Treg cells) in the pathogenesis of aplastic anemia (AA), myelodysplastic syndrome (MDS) and acute myeloid leukemia , To provide experimental evidence for clinical treatment. Methods 25 cases of AA, 48 cases of MDS [including 22 cases of refractory anemia (MDS-RA) and 26 cases of refractory anemia with proliferative myelocythemia (MDS-RAEB)] were detected by flow cytometry in AML group The proportion of Th1, Th2, Th17 and Treg cells in peripheral blood mononuclear cells of 8 cases and normal control group were compared and analyzed to evaluate the cellular immune status. Results Compared with the normal control group, the levels of Th1, Th17 cells and Th1 / Th2 in AA group were increased, while the ratios of Th2 and Treg cells were decreased (P <0.05). Compared with normal control group, the levels of Th1, Th2 and Th1 / (P <0.05), while the proportion of Th17 and Treg cells increased (P <0.05). The proportion of Th1 and Th17 cells and Th1 / Th2 in MDS-RA group were significantly increased (P <0.05) (P <0.05), while the proportion of Treg cells was not significantly different (P> 0.05). The proportion of Th1 and Th17 cells and Th1 / Th2 in MDS-RAEB group and AML group were significantly decreased Increased (P <0.05). Conclusions The cellular immune status of AA and MDS in different stages is different from that of AML patients. In the early stages of AA and MDS, immune-mediated excessive apoptosis is the main cause of bone marrow failure. In the late stage of MDS and AML stage, the number of abnormal clone cells Accumulation may be the main reason.