天疱疮患者皮损中CD4+定居记忆T细胞的浸润及其临床相关性分析

【摘要】 目的 探讨天疱疮皮损局部CD4+定居记忆T（TRM）细胞的浸润及其临床相关性。方法 2017年9月至2018年12月在上海交通大学医学院附属瑞金医院皮肤科收集天疱疮患者20例，健康对照15例。采用流式细胞仪检测天疱疮患者皮损和健康对照皮肤CD4+ TRM细胞的表达。比较天疱疮患者不同部位皮损处CD4+ TRM细胞的浸润情况，分析CD4+ TRM细胞比例与病情控制所需时间的关系。符合正态分布的资料采用t检验，不符合正态分布者采用非参数检验；采用Pearson相关系数分析CD4+ TRM细胞比例和天疱疮疾病面积指数（PDAI）评分、循环中抗桥粒芯糖蛋白（Dsg）抗体滴度的相关性。结果 20例天疱疮患者中16例为寻常型天疱疮，4例为落叶型天疱疮。所有患者均有皮肤累及，14例皮损组织取材于躯干部位，6例取材于四肢部位。健康对照组年龄、性别和取材部位与天疱疮组差异无统计学意义（均P > 0.05）。天疱疮患者皮损局部CD3+ T细胞（72.75% ± 8.22%）显著高于健康对照组（31.33% ± 8.72%，t = 14.24，P < 0.001），CD4+ TRM细胞比例（44.05% ± 14.27%）亦显著高于健康对照组（12.60% ± 5.12%，t = 9.10，P < 0.001）。天疱疮患者躯干部CD4+ TRM细胞比例（49.57% ± 12.32%）显著高于四肢（31.17% ± 9.75%，t = 3.23，P < 0.05）。皮损局部CD4+ TRM细胞比例与PDAI呈正相关（r2 = 0.246，P = 0.026）；而与血清中循环抗Dsg1（r2 = 0.137，P > 0.05）和抗Dsg3（r2 = 0.162，P > 0.05）抗体滴度无显著相关性。系统糖皮质激素治疗过程中4周内不能控制的患者皮损处CD4+ TRM细胞比例显著高于4周内可以控制的患者（t = 3.22，P < 0.05）。结论 天疱疮患者皮损局部CD4+ TRM细胞比例显著增高，可能与病情严重程度和疾病治疗反应相关。     

OKT_3~+细胞与E_t花环间,OKT_8~+细胞与E_a花环间相关性的再验证

本文报告用 Bǒyum 氏法分离形成 Et(总 E 玫瑰花环)或 Ea(活性 E 玫瑰花环)的相应 T 淋巴细胞。然后分别用单克隆抗体对所获得的 T 细胞进行间接免疫荧光检测。结果表明形成 Et 的T 细胞中93.5±6.0%为 OKT_3~+的成熟 T 细胞,形成 Ea 的 T 细胞中93.8±6.5%为抑制性及细胞毒性 T 细胞.这就进一步证明 OKT_3~+与 Et 间,以及 OKT_3~+与 Ea 间的确均存在显著的正相关.     

腹腔镜胃癌根治术对患者的手术创伤、T淋巴细胞的影响

目的探讨腹腔镜胃癌根治术对胃癌患者的手术创伤、术后T淋巴细胞亚群的影响。方法回顾性分析2015年1月至2016年8月手术治疗的90例胃癌患者资料,根据手术方法分为腹腔镜组43例(腹腔镜胃癌根治术)、开腹组47例(传统开腹手术),统计分析采用SPSS 16.0软件进行处理,术前术后指标、T淋巴细胞亚群采用均数±标准差(x珋±s)描述,两组间比较采用t检验;组内不同时间点比较采用LSD-t检验;P0.05表示差异具有统计学意义。结果腹腔镜组的出血量、肛门排气时间、下床活动时间、住院时间均低于开腹组(P0.05),腹腔镜组患者的手术时间长于开腹组患者(P0.05),两组患者的清扫淋巴结数目差异无统计学意义(P0.05);术前1天,两组患者的T淋巴细胞亚群测定结果差异无统计学意义(P0.05);术后1天,腹腔镜组患者的CD3+、CD4+、CD4+/CD8+测定值均高于开腹组(P0.05)。结论腹腔镜胃癌根治术对胃癌患者的创伤较小,对患者的免疫功能影响较小。     

DAB诱发大鼠肝癌过程中IL-2、T淋巴细胞亚群动态变化

目的:了解诱癌过程中大鼠免疫功能变化,观察大鼠IL-2、T淋巴细胞亚群动态变化及其相互关系。方法:应用二甲基奶油黄(DAB)诱发大鼠肝癌,在诱发大鼠肝癌的3个阶段分别取大鼠脾脏和外周血测定IL-2活性和T淋巴细胞亚群。结果:肝炎、肝硬变、肝癌期大鼠IL-2活性、Th降低有显著性,P<0.05或<0.01。肝癌期大鼠Ts显著增加,P<0.05。肝炎、肝硬变期IL-2活性与Th正相关,肝癌期大鼠IL-2活性与Ts负相关,与Th/Ts比值呈正相关。结论:诱发大鼠肝癌过程中,IL-2活性逐步降低,良性肝病期IL-2活性与Th下降有关,肝癌期IL-2活性与Ts增加和Th/Ts比值降低有关。肝炎期IL-2活性显著下降提示有早期肝癌发生的可能。     

Functional Modifications of Tee Cd4+and the Cd8+-H Subset Due to Maternal Serum

Abstract

Numerous experiments have been performed to try to explain the successful gestation of the semiallogeneic mammalian fetus in the immuno-competent mother (1, 3, 4, 5). A popular hypothesis is that localized intra uterine suppression mediates the immune response and contributes directly to the survival of the fetus (6). Suppressive factors synthesized at the fetomaternal interface may be transported by the bloodstream and be found in the retroplacental and peripheral blood circulation (7). In this report we aim to study these modulating factors by exposing a proteinaceous antigen (Candidine or human mono nuclear cells) to unrelated human lymphocytes in the presence of a pool of maternal serum, retroplacental (MAT SR) or peripheral (MAT SP), or to a pool of male or calf serum (MALS or CS).

A significant downregulation of the candidine mediated lymphocytic stimulation was observed in the case of the maternal serum. In order to further characterize this inhibition, a quantitative evaluation of the expression of the CD₄ and CD₈ positive subpopulations was performed. A selective inhibition of the CD₄ positive subset was observed.

In the PHA stimulation assay in the presence of maternal serum there was an inhibition of the thymidine uptake of unrelated lymphocytes. When studying the different subsets which were stimulated in the presence of maternal serum and control media it was shown that the CD₄ positive subpopulation remained unchanged while there was a slight inhibition of the CD₈ positive subset in the first case (maternal serum treated).

The same CD₄ positive inhibitive property of maternal serum was observed when a neoplastic cell line (HUT cells) was used as target for candidine in a stimulation test. This CD₄ inhibited expression remained constant as long as the maternal serum was renewed.

Maternal lymphocytes however remained resistant to the inhibitive action of maternal serum and did not show any change in their CD₄ and CD₈ positive subpopulation. By investigating the different blood components, it was shown that the suppressive factor was included in the IgG fraction and synthesized at the placental level. Appearing quite early during the gestation (at the 5-6th week), this factor was vanishing 2 weeks after the delivery.     

化疗对胃癌患者免疫功能的影响

背景：化疗药物可杀灭或抑制胃癌患者的肿瘤细胞，同时亦影响患者机体的免疫状态。分析胃癌患者化疗前后免疫状态的变化有助于准确实施化疗和综合治疗。目的：探讨化疗对胃癌患者免疫功能的影响。方法：共63例接受化疗的胃癌患者入选，化疗前后分别应用流式细胞仪和酶联免疫吸附测定（ELISA）检测外周血T细胞亚群和血清可溶性白细胞介素-2受体（sIL-2R）水平，并设健康者作为正常对照组。结果：胃癌患者化疗前CD3^＋、CD4^＋T细胞数以及CD4^＋／CD8^＋比值显著低于正常对照组（P〈0．05），血清sIL-2R水平显著升高（P〈0．05）。化疗后1周胃癌患者CD3^＋、CD4^＋T细胞数、CD4^＋／CD8^＋比值较化疗前显著降低（P〈0．05），血清sIL-2R水平显著升高（P〈0．05）；化疗后3周，上述指标逐渐恢复。与化疗前水平相比无明显差异，但与正常对照组相比差异仍有统计学意义（P〈0．05）。化疗过程中最常见的不良反应为恶心、呕吐（68.3％）和骨髓抑制（46．0％）。结论：胃癌患者在短期化疗后出现的免疫功能抑制需3周以上才能明显恢复。应于化疗早期使用免疫增强调节剂，以利于实施有效的综合治疗。     

CD4+ and CD8+ subsets: Naive and memory cells in the peripheral blood of patients with systemic sclerosis

Summary Systemic Sclerosis (SSc; scleroderma) is associated with several immunological abnormalities, including altered proportion between lymphocyte subsets. Peripheral blood lymphocyte subsets from 25 patients with SSc were studied by two-colour flow cytometry using monoclonal antibodies against CD45RA and CD29 markers, which allow a dissection of CD4+ and CD8+ populations into naive and memory subsets. A decrease of the percentage of CD8+ (p<0.05) and of CD8+ CD29+ (p<0.001) cells was observed compared to that in 20 age and sex-matched controls. These abnormalities were not significantly associated with the extension of cutaneous disease or other clinical features of SSc nor with treatment, pattern of autoantibodies or HLA phenotype.     

Treg/Th17与免疫性血小板减少症中医证型的相关性

摘要目的:探讨Treg/Th17 失衡在免疫性血小板减少症（ITP）中医“血热妄行”、“阴虚火旺”、“气不摄血”证型中的作用及意义;方法:流式细胞术（FCM）检测92例ITP患者（血热妄行组31例,阴虚火旺组31例,气不摄血组30例）及30例健康志愿者外周血Th17 细胞和Treg 细胞的数量;RT-PCR用于检测Foxp3 mRNA和ROR-γt水平,比较各组间上述指标的差异。结果：3组不同证型的ITP患者外周血treg细胞数量均低于正常对照组(p<0.05),且血热妄行组低于气不摄血组(p<0.05),气不摄血组低于阴虚火旺组(p<0.05),血热妄行组低于阴虚火旺组(p<0.05),组间两两比较差异均有统计学意义。3组不同证型 ITP外周血Th17细胞数量显著高于正常对照组(p<0.05),血热妄行组高于气不摄血组及阴虚火旺组(p<0.05),比较差异有统计学意义。气不摄血组高于阴虚火旺组(p>0.05),差异无统计学意义。3组Treg/Th17较对照组相比均降低(p<0.05),血热妄行组低于气不摄血组(p<0.05)差异有统计学意义,气不摄血组低于阴虚火旺组(p<0.05)差异有统计学意义,血热妄行组低于阴虚火旺组(p<0.05)差异有统计学意义。3组不同证型的ITP患者Foxp3 mRNA水平均低于正常对照组(p<0.05),且各组间两两比较差异有统计学意义。3组不同证型ROR-γt水平高于正常对照组（P＜0.01)。Treg 细胞数量表达水平、Foxp3 mRNA水平在ITP 各证型间的分布规律为血热妄行组＜气不摄血组＜阴虚火旺组。结论：ITP患者中Treg 细胞数量减少参与了ITP的发生发展,Treg/Th17比例失衡在ITP的发病机制中可能有重要作用。Treg 细胞数量表达水平、Foxp3 mRNA水平及Treg/Th17比例在不同中医证型ITP中有差异。     

甲型H1N1流感56例临床分析

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