骨髓增生异常综合征患者骨髓CD34+细胞亚群及其表面造血因子受体的表达

目的 探讨骨髓增生异常综合征(MDS)患者骨髓CD34+细胞亚群及其表面干细胞因子受体(SCF-R)、红细胞生成素受体(EpoR)、粒细胞集落刺激因子受体(G-CSFR)及血小板生成素受体(TpoR)的表达情况及其意义.方法 采用流式细胞术检测2008年7月至2010年3月天津医科大学总医院新诊断的45例MDS患者(17例低危患者、28例高危患者)及30名对照组原代骨髓CD34+CD38+及CD34+CD38-细胞亚群及其表面SCF-R、EpoR、G-CSFR及TpoR的表达率.结果 高危组CD34+细胞比例[0.53%(0.10%～1.68%)]明显高于对照组[0.13%(0.08%～0.32%),P＜0.01],其他2组间比较差异无统计学意义.低危组和高危组CD34+CD38+细胞比例(86.3%±8.5%、82.6%±11.1%)显著低于对照组(92.3%±3.4%,均P＜0.05),而CD34+CD38-细胞比例(13.7%±8.5%、17.4%±11.0%)显著高于对照组(7.7%±3.4%,均P＜0.05).对照组骨髓CD34+CD38+细胞亚群EpoR表达率(18.7%±18.3%)显著低于CD34+CD38-细胞亚群(63.6%±20.0%,P＜0.01),两亚群之间SCF-R、G-CSFR及TpoR表达率差异无统计学意义.在CD34+CD38+细胞亚群中,3组间SCF-R和TpoR表达率差异无统计学意义,而低危组和高危组EpoR的表达率[9.0%(1.4%～12.7%)、5.2%(1.1%～14.1%)]明显低于对照组[9.6%(5.1%～30.1%),均P＜0.05],G-CSFR的表达率(29.8%±19.1%、28.7%±21.1%)明显低于对照组(44.4%±23.4%,均P＜0.05);在CD34+CD38-细胞亚群中,3组间SCF-R和G-CSFR表达率差异无统计学意义,低危组和高危组EpoR的表达率(42.2%±21.9%、25.7%±15.6%)明显低于对照组(63.6%±20.0%,均P＜0.01),TpoR的表达率(5.4%±4.7%、4.1%±4.0%)明显低于对照组(10.1%±8.3%,均P＜0.05).MDS患者骨髓CD34+CD38+和CD34+CD38-细胞亚群表面受体表达率低的患者其外周血血红蛋白水平、中性粒细胞及血小板计数减低的发生率明显高于受体表达率不低的患者(均P＜0.05).结论 MDS患者的原代骨髓CD34+细胞亚群分化异常,膜表面部分造血细胞因子受体表达减低,这可能与MDS患者血细胞减少有关,有望用于辅助诊断MDS.

Abstract：

Objective To detect the abnormalities of differentiation and expression of membrane hemopoietic cytokine receptors on CD34 + bone marrow cells in patients with myelodysplastic syndromes (MDS). Methods Forty-five newly diagnosed MDS cases from July 2008 to March 2010 in our hospitaland 30 normal controls were enrolled. There were 17 low-risk and 28 high-risk patients. The CD34 + CD38 +and CD34 + CD38- bone marrow cells and the expressions of stem cell factor receptor (SCF-R),erythropoietin receptor (EpoR), granulocyte colony-stimulating factor receptors (G-CSFR) and thrombopoietin receptor (TpoR) on those cells were measured by flow cytometry. Results The mean percentage of CD34+ in karyocyte of MDS cases in high-risk patients [0. 53% (0. 10% - 1.68% )] was significantly higher than that of control group [0. 13% ( 0. 08% - 0. 32% ), P ＜ 0. 01] . The mean percentages of CD34 + CD38 + cells were significantly lower in low and high-risk groups (86. 3% ± 8.5% and 82. 6% ± 11.1% ) than those in control group (92. 3% ± 3.4% ). And the percentage of CD34+ CD38-cells was significantly higher in either low-risk or high-risk group ( 13.7% ±8. 5% and 17.4% ± 11.0% )than that in control group (7.7% ± 3.4%, both P ＜ 0. 05 ). In control group, the mean percentage of antigen expression of EpoR was significantly lower in CD34 + CD38 + cells than that in CD34 + CD38 - cells ( 18.7% ± 18. 3% vs 63. 6% ±20. 0%, P ＜0. 01 ). The expressions of SCF-R, G-CSFR and TpoR were not significantly different between two cell populations. The expressions of EpoR on CD34 + CD38 + cells of low and high-risk MDS groups [9.0% ( 1.4% - 12. 7% ), 5. 2% ( 1.1% - 14. 1% )] were significantly lower than those of control group [9. 6% (5.1% - 30. 1% ), both P ＜ 0. 05]. The expressions of G-CSFR on CD34+CD38+ cells of low and high-risk MDS groups (29.8% ± 19. 1%, 28.7% ± 21.1%) were significantly lower than those of control group (44.4% ± 23.4%, both P ＜ 0. 05 ). The quantities of EpoR on CD34 + CD38 - cells of low and high-risk MDS groups ( 42. 2% ± 21.9%, 25.7% ± 15. 6% ) were significantly lower than those of control group ( 63. 6% ± 20. 0%, both P ＜ 0. 01 ). The expressions of TpoR on CD34+ CD38- cells of low and high-risk MDS groups (5.4% ± 4.7%, 4.1% ± 4.0%) were significantly lower than those of control group ( 10. 1% ± 8. 3%, both P ＜ 0. 05 ). The incidence of cytopenia with low expression rates of hemopoietic cytokine receptors on CD34 + cells was higher than that of MDS with high expression rates. Conclusion The abnormalities of differentiation and membrane hemopoietic cytokine receptors expression of CD34 + bone marrow cells in MDS are associated with MDS cytopenia and may be useful for the diagnosis of MDS.     

骨髓增生异常综合征中骨髓CD34~+、CD34~-细胞凋亡和增殖的实验研究

目的:分析骨髓增生异常综合征(MDS)患者骨髓CD34+细胞和CD34-细胞凋亡和增殖情况,从该角度探讨MDS的发病机制。方法:流式细胞术分析20例高危MDS、20例低危MDS患者及10例正常对照者骨髓CD34+细胞的比例,CD34+细胞和CD34-细胞凋亡、增殖的百分率,计算各组中的凋亡/增殖(A/P)比。结果:(1)MDS患者CD34+细胞的比例明显高于对照组,其中高危组CD34+细胞的比例明显高于低危组(P<0.05),而低危组与对照组比较无显著差异;(2)CD34+,CD34-细胞的凋亡率在MDS低危组中均为最高,明显高于MDS高危组和对照组,在低危组中,CD34-细胞的凋亡率(80.36±1.82)%明显高于CD34+细胞(54.75±2.18)%(P<0.05),而在高危组中,CD34+,CD34-细胞的凋亡率无显著差异;(3)CD34+细胞的增殖率在MDS高危组中最高,明显高于低危组和对照组,而CD34-细胞的增殖率在MDS高危和低危组间无显著差异,在高危组中,CD34+细胞的增殖率(50.67±3.37)%明显高于CD34-细胞的(30.99±1.96)%(P<0.05);(4)无论CD34+,CD34-细胞的A/P值在MDS低危组中均明显高于高危组和正常对照组,而在MDS各亚组中,CD34-细胞的A/P值明显高于CD34+的A/P值(P<0.05)。结论:CD34+细胞百分率随MDS危险度增加而逐渐增加,在低危组中以CD34-细胞的凋亡占主导,随着病情进展,在高危组中则以CD34+细胞的增殖占主导,提示异常的凋亡和增殖在MDS的发生和发展中起重要作用。     

化疗+G-CSF方法动员外周血干细胞时骨髓及外周血相关细胞亚群的动态变化

目的探讨应用化疗 G-CSF方法动员外周血干细胞时,恶性血液病患者的骨髓及外周血CD34 细胞和T细胞亚群的变化特点.方法 16例拟行自体外周血干细胞移植患者,在应用化疗 G-CSF方法动员外周血干细胞期间,应用流式细胞仪测定骨髓及外周血CD34 和T细胞亚群动态变化情况.结果 1.恶性血液病患者在应用G-CSF前,骨髓中CD34 细胞的初始值为(0.52±0.31)%.应用G-CSF 48 h后,CD34 细胞测定值为(1.22±0.42)%,较前有明显增加(P＜0.001).CD34 细胞的高峰值出现在应用G-CSF 96 h后,为(2.23±0.34)%,较未应用G-CSF时差异显著(P＜0.001).2.恶性血液病患者在应用G-CSF前,外周血CD34 细胞测定值为(0.39±0.27)%.在应用G-CSF 72 h后外周血中CD34 细胞的测定值为(1.29±0.64)%,较前有明显增加(P＜0.001).应用G-CSF96 h后,CD34 细胞的测定值达高峰,为(1.41±0.73)%,较未应用G-CSF前差异显著(P＜0.001).3.无论是否应用G-CSF,恶性血液病患者的T淋巴细胞亚群比例均处于倒置状态,应用G-CSF后随CD34 细胞的逐渐增加,T淋巴细胞亚群变化不明显(P＞0.05).结论恶性血液病患者,在应用化疗 G-CSF动员外周血干细胞时,其骨髓及外周血CD34 细胞和T细胞亚群的动态变化各有其特点.     

Liposome-mediated Functional Expression of Multiple Drug Resistance Gene in Human Bone Marrow CD34＋ Cells

Myelosuppressionisanimportantdose limitingfactorformostofchemotherapeuticagentsinclinicalpractice.OverexpressionofP glycoprotein (P gp)encodedbyMDR1geneisaccompaniedbyfunctionaldrugresistance.TheexpressionofP gpisconsistent lylowinnormalbonemarrowcells,an…     

CD47在急性髓细胞白血病干细胞中的表达及其临床意义探讨

目的探讨CD47在急性髓细胞白血病干细胞(AML LSCs)中的表达及临床意义。方法应用流式细胞仪检测19名健康对照者骨髓造血干细胞(HSC)及147例AML患者骨髓LSCs中CD47的表达。对其中131例AML患者进行跟踪随访,分析LSCs CD47阳性和阴性对AML预后的影响。结果 19名健康对照骨髓HSC CD47阳性4例(21.05%),147例AML患者LSCs CD47阳性112例(76.19%),明显高于对照组,差异有统计学意义(χ2=24.30,P<0.01)。CD47在LSCs中表达百分率和平均荧光强度(MFI)均高于CD34+CD38+亚群(U值分别为4.90、3.03,P均<0.01)。对131例AML进行1～31个月随访:CD47阳性的AML患者复发率为46.46%(46/99),病死率为43.43%(43/99),CD47阴性的AML患者复发率为25.00%(8/32),病死率为18.75%(6/32),两者差异有统计学意义(χ2值分别为4.60、6.29,P均<0.05)。生存分析显示,CD47阳性的AML患者平均生存时间18.99±1.15个月,CD47阴性的AML患者平均生存时间24.90±1.87个月,两者差异有统计学意义(P<0.05)。结论 LSCs CD47阳性的AML患者易复发、病死率高、生存时间短、预后差。     

骨髓增生异常综合征患者骨髓造血细胞分化抗原表达及其意义

目的 了解骨髓增生异常综合征(MDS)患者骨髓成熟粒系和红系细胞分化抗原表达特点并分析其与IPSS、WPSS评分的相关性.方法 采用流式细胞术检测34例(12例低危、22例高危)MDS患者及31名正常骨髓粒系CD11b、CD13、CD16、HLA-DR以及红系CD71和血型糖蛋白A(GlyA)抗原的序贯表达比例和模式.结果 选择CD13/CD11b、CD13/CD16及CD11b/CD16组合来分析粒细胞分化抗原表达模式,对照组骨髓粒系细胞组合模式分别为"对钩"、"镰刀"或"反7"状,MDS患者骨髓粒系细胞发育分化中的抗原表达模式出现不同程度的改变.高危组CD11b-/CD11b+比值(0.39±0.34)明显高于低危组(0.10±0.09)和对照组(0.07±0.05)(P<0.01);高危组CD16-/CD16+比值(1.33±0.77)明显高于对照组(0.39 ±0.31)(P<0.05);低危和高危组骨髓粒细胞CD13的平均荧光强度(MFI)高于对照组,侧向角散射光信号(SSC)的MFI低于对照组,但差异无统计学意义.高危组CD11b-HLA-DR+3.88%±3.07%、CD11b-HLA-DR-16.23%±15.59%、CD16-HLA-DR-41.12%±24.53%、CD11b+CD16-33.53%±17.26%及CD13+CD16-44.51%±21.99%细胞占粒细胞比例明显高于低危组和对照组(P<0.05),其他组间比较差异无统计学意义.应用CD71和GlyA的组合来分析红系细胞的分化,对照组两种抗原的组合模式均为双阳性表达,部分MDS患者可见CD71和GlyA表达不同步现象.低危组和高危组CD71+和GIyA+双阳性细胞分别占CD45-细胞和GIyA+细胞的比例均显著低于对照组.MDS患者粒、红系抗原表达的比例和模式异常数目与IPSS积分(r=0.690,P=0.000)、WPSS积分(r=0.651,P=0.000)均呈正相关.结论 MDS患者造血细胞分化抗原表达异常,异常程度与预后相关.这提示分化抗原检测可能有助于MDS患者的诊断和预后判断.     

骨髓基质细胞衍生因子1及其受体在骨髓增生异常综合征患者中的表达

目的 探讨基质细胞衍生因子1(SDF-1)与其受体趋化因子受体CXCR4在骨髓增生异常综合征(MDS)发病中的可能作用,为MDS的治疗寻找有意义的靶点.方法 收集2006年10月至2010年6月59例MDS病例,根据国际预后积分系统(IPSS)分为低危和高危两组,分别为33例和26例,以10份正常的骨髓标本作为对照.采集骨髓标本,检测骨髓血浆中SDF-1的含量、CD34+细胞CXCR4的表达率、CD34+细胞的凋亡率及血管内皮生长因子(VEGF)在骨髓血浆中的表达.结果 SDF-1在低危组和高危组患者骨髓血浆中的含量[(2301±413)、(1173 ±501)ng/L]显著高于对照组[(689±190)ng/L,P＜0.05],低危组显著高于高危组(P＜0.05).CD34+细胞CXCR4的表达在高危组(68.1％±18.8％)显著高于低危组(21.0％±9.7％)和对照组(19.4％±5.3％)(P＜0.05),在后两组的表达率差异无统计学意义(P＞0.05).CD34+细胞的凋亡率在低危组、高危组和对照组分别为54.8％±10.2％,24.3％±7.9％,l8.5％±8.7％,前组显著高于后两组(P＜0.05).骨髓血浆中VEGF的含量在低危组、高危组、对照组分别为(286±97)、(407±168)、(157±46)ng/L,差异有统计学意义(P＜0.05).相关分析显示:低危组CD34+细胞的凋亡率与骨髓血浆SDF-1的含量呈正相关(r =0.805,P＜0.05);高危组血浆VEGF的含量与CD34+细胞CXCR4的表达呈正相关(r=0.683,P＜0.05).结论 SDF-1/CXCR4在MDS中存在异常表达,且与骨髓细胞的凋亡和血管新成具有相关性,针对该生物轴的干预可为该病的治疗提供新的靶点.     

BURDEN OF ABNORMAL HEMATOPOIETIC CLONE IN PATIENTS WITH MYELODYSPLASTIC SYNDROMES

MYELODYSPLASTIC syndromes (MDS) is agroup of clone hematopoietic stem cell diseasescharacterized by dysplasia and ineffective hem-atopoiesis in one or more of the myeloid cell lines·1Studiesindicated that recurring chromosomal abnormalities werefound in4…     

阵发性睡眠性血红蛋白尿症患者CD34+CD59-与CD34+CD59+细胞膜EPO、TPO受体后STAT5磷酸化水平的关系

目的 观察阵发性睡眠性血红蛋白尿症(PNH)患者骨髓CD34+CD59+和CD34+CD59-细胞膜促红细胞生成素(EPO)受体(EPOR)、血小板生成素(TPO)受体(TPOR)后信号转导通路中信号转导和转录激活因子(STAT)5磷酸化水平.方法 应用流式细胞术分别检测2010年4月至2011年2月天津医科大学总医院血液肿瘤科PNH患者23例及11名健康对照骨髓单个核细胞(BMMNC)经和不经10 U/ml EPO、50 U/ml TPO刺激后CD34+CD59-和CD34+CD59+细胞磷酸化STAT5(P-STAT5)的平均荧光强度(MFI).结果 (1)未加入细胞因子时,PNH患者CD34+CD59-细胞P-STAT5的MFI为31±15,明显低于 CD34+CD59+细胞(74±47,P<0.01)及健康对照组CD34+CD59+细胞(59±23,P<0.05);PNH患者CD34+CD59+细胞P-STAT5的MFI与健康对照组CD34+CD59+细胞比较差异无统计学意义(P>0.05).(2) EPO、TPO刺激后,PNH患者CD34+CD59-细胞P-STAT5的MFI分别为49±24、51±41,明显低于CD34+CD59+细胞(120±82、124±87,均P<0.01)及健康对照组CD34+CD59+细胞(79±47、98±53,均P<0.05),PNH患者CD34+CD59+细胞P-STAT5的MFI与健康对照组CD34+CD59+细胞比较差异无统计学意义,经EPO、TPO刺激后PNH患者CD34+CD59+细胞P-STAT5的增高值分别为49±11、54±43,明显高于CD34+CD59-细胞(17±4、16±6,均P<0.01).结论 体外予EPO、TPO刺激,PNH患者正常克隆造血干细胞(CD34+CD59+)EPO、TPO受体后信号转导通路中STAT5磷酸化水平明显优于异常克隆造血干细胞(CD34+CD59-).

Abstract：

Objective To study the STAT5 phosphorylation levels of erythropoietin receptor (EPOR) and thrombopoietin receptor (TPOR) in CD34+CD59- and CD34+CD59+ bone marrow cells of the patients with paroxysmal nocturnal hemoglobinuria (PNH).Methods The bone marrow mononuclear cells (BMMNC) were extracted from 23 PNH patients treated at our department from April 2010 to February 2011 and 11 normal controls. The mean fluorescence intensity (MFI) of phosphorylated STAT5 (P-STAT5) in CD34+CD59+cells and CD34+CD59-cells with or without the stimulation of 10 U/ml EPO and 50 U/ml TPO were examined by flow cytometry.Results (1)Without stimulation, the P-STAT5 MFI in CD34+CD59- cells of PNH patients was significantly lower than that of CD34+CD59+cells (31±15 vs 74±47, P<0.01). And it was 59±23 in normal control CD34+CD59+cells (P<0.05). No statistic difference existed between the CD34+CD59+cells of PNH patients and the normal control CD34+CD59+cells. (2)Under the stimulations of EPO and TPO, the P-STAT5 MFI was significantly lower in CD34+CD59-cells of PNH patients than that of CD34+CD59+cells (49±24 and 51±41 vs 120±82 and 124±87, both P<0.01). For the normal control CD34+CD59+cells, they were 79±47 and 98±53 respectively (P<0.05).No statistic difference existed between the CD34+CD59+cells of PNH patients and the normal control CD34+CD59+cells. P-STAT5 MFI was elevated after the stimulations of EPO and TPO. The increments of CD34+CD59+cells in PNH patients were significantly higher than those of CD34+CD59-cells (49±11 and 54±43 vs 17±4 and 16±6, both P<0.01).Conclusion Under the in vitro stimulations of EPO and TPO, the STAT5 phosphorylation levels of EPO and TPO receptors in normally cloned hematopoietic stem cells in PNH patients are obviously superior to those in abnormally cloned counterparts.     

重型再生障碍性贫血患者外周血自然杀伤细胞亚群百分比及功能变化

目的 分析重型再生障碍性贫血(SAA)患者免疫抑制治疗(IST)前、后外周血自然杀伤(NK)细胞亚群占淋巴细胞百分比、功能变化及其与造血功能相关性,探讨NK细胞在SAA发病机制中的作用.方法 用流式细胞术检测2010年4月至2010年12月天津医科大学总医院收治的12例初治(初治组)、30例IST后恢复(恢复组)的SAA患者的外周血NK细胞(CD3-CD56+/CD16+)及其亚群[CD3-CD56brightCD16-(CD56bright)、CD3-CD56dimCD16+(CD56dim)、CD3-CD56-CD16+]占淋巴细胞百分比、活化性受体(NKG2D和NKp46)、穿孔素、颗粒酶β表达,并与13名健康对照(对照组)比较;分析上述变化与外周血中性粒细胞比例(ANC%)、淋巴细胞比例、网织红细胞计数及骨髓造血功能(增生程度、粒系百分比、红系百分比、巨核细胞数量、淋系百分比)的相关性.结果 (1)初治组NK细胞、CD56bright细胞百分比(10.30%±6.08%、0.11%)均显著低于恢复组(16.47%±8.29%、0.68%,P＜0.05)和对照组(19.45%±6.88%、0.53%,均P＜0.05);初治组CD56dim细胞百分比(9.62%±6.04%)明显低于对照组(18.21%±7.16%,P＜0.05);恢复组CD3-CD56-CD16+细胞百分比(0.79%)显著高于初治组及对照组(0.37%、0.41%,均P＜0.05).(2)初治组与恢复组NK细胞NKp46、穿孔素表达[初治组(88.23%、64.97%±21.61%),恢复组(82.97%、66.14%±20.73%)]显著高于对照组(40.99%、42.11%±27.25%,均P＜0.05).(3)NK、CD56bright及CD3-CD56-CD16+细胞的百分比与SAA患者ANC%呈正相关(r分别为0.423、0.609、0.468,均P＜0.05),与骨髓粒系百分比呈正相关(r分别为0.357、0.517、0.434,均P＜0.05);NK、CD56bright、CD56dim和CD3-CD56-CD16+细胞的百分比与SAA患者骨髓增生程度呈正相关(r分别为0.455、0.412、0.404、0.451,均P＜0.05),与骨髓淋系百分比呈负相关(r分别为-0.522、-0.435、-0.411、-0.547,均P＜0.05);NK细胞NKG2D、NKp46、穿孔素、颗粒酶β表达与各造血指标无相关性(均P＞0.05).结论 SAA患者外周血NK细胞、CD56bright、CD56dim亚群占淋巴细胞百分比降低及穿孔素途径增强可能引起免疫耐受被破坏、T细胞功能亢进而导致造血功能衰竭.

Abstract：

Objective To analyze the percentage and functional changes of natural killer(NK)cell subsets in peripheral blood of severe aplastic anemia(SAA)patients before and after immunosuppressive therapy(IST)so as to evaluate the relationships between these changes and hematopoietic functions and explore the role of NK cells in the pathogenesis of SAA.Methods By flow cytometry,the percentages of NK cells(CD3-CD56+/CD16+)and its subsets[CD3-CD56brightCD16-(CD56bright),CD3-CD56dimCD16+(CD56dim),CD3-CD56-CD16+]in peripheral blood lymphocytes were detected in 12 untreated patients,30 recovered patients and 13 normal controls respectively from April 2010 to December 2010 in our hospital.NK cells activating receptors(NKG2D and NKp46),pofforin and granzyme-β of patients and normal controls were also detected.The correlation between these changes and hematopoietic functions,including the percentages of neutrophil granulocyte(ANC%),lymphocyte and reticulocyte absolute value in peripheral blood,and hyperplasia degree,percentage of granulocytes,erythrocytes,lymphocytes and megakaryocytes absolute value in bone marrow were evaluated.Results (1)The percentages of NK cells (10.30% ± 6.08%)and CD56 bright cells(0.11%)in untreated patients were significantly lower than those of recovered patients(16.47% ± 8.29%,0.68%,both P ＜0.05)or normal controls(19.45% ±6.88%,0.53%,both P ＜0.05).The percentage of CD56dim cells in untreated patients was significantly lower than that of normal controls(9.62% ±6.04% vs 18.21% ±7.16%,P ＜0.05).The percentage of CD3 CD56 CD16 + cells was significantly higher in recovered patients than that of untreated patients or normal controls(0.79% vs 0.37%,0.41%,both P＜0.05).(2)The expression of NKp46 and pefforin of NK cells in untreated(88.23%,64.97% ± 21.61%)and recovered patients(82.97%,66.14% ±20.73%)were significantly higher than those of healthy controls(40.99%,42.11% ±27.25%,all P ＜0.05).(3)The percentage of NK CD56bright and CD3-CD56-CD16+ cells of patients was positively correlated with ANC%(r=0.423,0.609,0.468 respectively,all P＜0.05)and the percentage of granulocytes in bone marrow(r=0.357,0.517,0.434 respectively,all P＜0.05).The percentages of NK,CD56bight,CD56dim and CD3-CD56-CD16+ cells were positively correlated with the hyperplasic degree of bone marrow(r=0.455,0.412,0.404,0.451 respectively,all P＜0.05),but they were negatively correlated with the percentage of lymphocytes in bone marrow(r =-0.522,-0.435,-0.411,-0.547 respectively,all P ＜0.05).The expression of NKG2D,NKp46,pefforin and granzyme-β of NK cells had no correlation with hematopoiesis(all P＞0.05).Conclusion The lowered percentage of NK CD56bright,CD56dim cells and a higher expression of pefforin may cause the over-function of T lymphocytes and thus lead to hematopoietic failure in SAA.     

白血病K562/ADM细胞耐药性与白血病干细胞及耐药蛋白表达的关系

目的 观察白血病药物敏感和耐受细胞中白血病干细胞(ISC)、耐药蛋白表达和耐药性的关系.方法 以白血病多药耐药株K562/ADM细胞及其亲本K562细胞为模型,MTT比色法测定细胞的药物耐受性;流式细胞术检测细胞免疫标志、P-糖蛋白(P-gp)和乳腺癌耐药蛋白(BCRP)的表达;甲基纤维素集落形成法检测细胞的自我更新和增殖潜能.结果 K562/ADM细胞对阿霉素、柔红霉素和鬼臼乙叉苷高度耐受.K562/ADM细胞中CD34+、CD123+和CD34+CD38-细胞含量均显著高于K562细胞,LSC细胞相对含量是K562细胞的4.12倍;共表达P-gP和BCRP的K562/ADM细胞比K562细胞高11.25倍,其中CD34+ CD38- CD123+ BCRP+和CD34+ CD38- P-gp+ BCRP+细胞数量分别为K562细胞的3.66倍和11.37倍.K562/ADM细胞集落形成率是K562细胞的4.17倍,与LSC含量相当.结论 白血病K562/ADM耐药细胞中存在的高表达耐药蛋白的耐药性LSC是其多药物耐受性的根源.     

CD133 在骨髓增生异常综合征患者中的表达及临床意义

摘要：目的探讨骨髓增生异常综合征（MDS）患者骨髓中CD133的表达及其临床意义。方法应用流式细胞仪采用直接
免疫荧光标记法,分别测定31例难治性贫血伴幼稚细胞增多（RAEB）、10例难治性血细胞减少伴多系发育异常（RCMD）
以及11例再生障碍性贫血患者骨髓中CD133+细胞和CD34+/CD38-细胞比例,对比分析CD133及CD34/CD38在不同亚型
MDS中的表达及临床意义。结果在RAEB型MDS患者骨髓有核细胞中,CD133阳性细胞平均占6.75%,RCMD患者平
均占1.41%,而再生障碍性贫血对照组占2.70%,RAEB组显著高于其他两组（P<0.05）;再障对照组与RCMD组之间无显
著性差异（P>0.05）;CD34+/CD38-细胞比例在3组中均小于1%,统计学上无显著性差异（P>0.05）。结论CD133在MDS
的进展类型RAEB患者骨髓细胞中高表达,CD133有助于RAEB分型诊断;而CD34+/CD38-标记在MDS分型诊断中并无
价值。     

肾母细胞瘤基因衍生肽诱导细胞毒性T淋巴细胞对白血病患者骨髓CD34+细胞的体外杀伤效应

目的 探讨肾母细胞瘤基因(WT1)衍生肽负载树突状细胞(DC)诱导细胞毒性T淋巴细胞(CTL)对白血病CD34+细胞的体外清除效应.方法 合成一段针对HLA-A*0201锚位的WT19聚肽,体外负载来源于HLA-A*0201*健康人的DC后,诱导产生WT1肽特异性CTL(A组),以噻唑盐(MTT)比色法观察其对WT1表达阳性白血病患者(HLA-A* 0201+者3例,HLA-A*0201-者3例)骨髓CD34+细胞、健康人(HLA-A*0201+者2例,HLA-A*0201-者1例)外周血CD34+细胞和白血病NB4、K562及U937细胞株的体外杀伤效应,粒细胞-巨噬细胞系集落形成试验观察其对白血病患者骨髓CD34+细胞和健康人外周血CD34+细胞粒细胞-巨噬细胞系集落形成单位(CFU-GM)形成的影响.设立单独DC诱导CTL(B组)和IL-2诱导T细胞(C组)作为对照.结果 在效靶比为20:1时,A组CTL对3例HLA-A*0201+白血病患者骨髓CD34+细胞和NB4细胞的杀伤活性(分别为55.3%±2.8%,67.1%±3.2%、49.4%±3.8%和55.0%±3.7%)明显高于对3例HLA-A*0201-白血病患者骨髓CD34+细胞、健康人外周血CD34+细胞及K562、U937细胞的杀伤活性(均<20%),并明显高于B组和C组CTL(均P＜0.01).2例HLA-A*0201+白血病患者骨髓CD34+细胞经A组CTL处理后CFU-GM集落相对形成率分别为17.8%±4.0%和20.8%±3.4%,明显低于经B组CTL处理后(分别为88.9%±3.4%和91.8%±5.7%,均P＜0.01);HLA-A*0201-白血病患者骨髓CD34+细胞、健康人外周血CD34+细胞经A组和B组CTL处理后CFU-GM集落相对形成率差异尤统计学意义.结论 WT1肽特异性CTL能够以HLA-1类抗原限制方式杀伤高表达WT1基因的白血病CD34+细胞,且能特异性抑制其CFU-GM集落形成,WT1基因的表达产物可以作为清除白血病CD34+细胞靶点.     

骨髓增生异常综合征患者白血病干细胞的表达

目的：检测细胞表面抗原 CD123（IL -3受体α链）在骨髓增生异常综合征（Myelodysplastic syndrome , MDS）患者骨髓中的表达,并探讨其与患者预后的关系。方法选择2010年11月至2012年8月在泰山医学院附属医院就诊的53例 MDS 患者及30例非恶性血液病患者骨髓标本,采用流式细胞术检测 CD34＋ CD38- CD123＋的表达情况;同时依据国际预后积分系统（IPSS）将 MDS 患者划分为低危组、中危- I 组、中危- II 组和高危组,分析CD34＋ CD38- CD123＋的表达与 MDS 患者预后的相关性。结果53例 MDS 患者骨髓 CD34＋ CD38- CD123＋/CD34＋表达为14.29±7.89%,显著高于对照组的表达水平1.22±0.89%,t ＝9.013,P ＝0.000;其中高危组 CD34＋CD38- CD123＋/ CD34＋的比例显著高于中危- I 组和低危组,P ﹤0.01;中危- II 组显著高于低危组和中危- I 组, P ﹤0.01,中危- I 组高于低危组,P ﹤0.05。结论在 MDS 患者骨髓单个核细胞中 CD123异常过度表达,有助于MDS 的诊断及预后判断。     

胎儿骨髓基质细胞与外源性细胞因子的协同造血支持作用

目的 :探讨胎儿骨髓基质细胞与外源性细胞因子的协同造血支持作用。方法 :联合应用胎儿骨髓基质细胞与外源性细胞因子如重组人干细胞因子 (rh SCF)、IL - 3、IL - 6、粒巨噬细胞集落刺激因子 (GM- CSF)、粒细胞集落刺激因子 (G- CSF)、促红细胞生成素 (EPO)等先后对成人骨髓单个核细胞及 CD34 + 富集细胞培养 5 d至 2周。结果 :胎儿骨髓基质细胞与上述细胞因子具有良好的协同作用 ,CD34 +富集细胞以胎儿骨髓基质细胞 +SCF+IL- 3+IL- 6 +G- CSF+EPO培养 2周 ,可使细胞总数、粒 -单系造血祖细胞 (CFU- GM)、早期红系造血祖细胞 (BFU- E)及 CD34 +细胞分别扩增 (119.6± 30 .9)倍、(5 4.6± 17.4)倍、(2 5 .2± 4.4)倍、(11.1± 4.2 )倍。结论 :胎儿骨髓基质细胞可协同上述外源性细胞因子支持成人骨髓造血祖细胞的有效扩增     

多发性硬化患者造血干/祖细胞及其亚群富集纯化的研究

目的：获得高纯度造血干／祖细胞(HSC／HPC)及其亚群,用于多发性硬化(MS)造血干细胞移植治疗和生物学特性的研究．方法：用免疫磁珠法(MiniMACS)从MS患者骨髓中富集CD34^ 细胞后再用荧光激活细胞分选(fluorescent acti—vated cell sorter,FACS)纯化CD34^ ／CD38^ 和CD34^ ／CD38^-细胞亚群．结果：MiniMACS分选的CD34^ 细胞群纯度达91％,FACS分选的CD34^ ／CD38^-和CD34^ ／CD38^ 两细胞亚群纯度可达98％以上．结论：MiniMACS和FACS两者结合可迅速大量纯化HSC／HPC及其重要细胞亚群,可用于临床MS造血干细胞移植、基因治疗和研究HSC／HPC及其亚群生物学特征．     

CD123在儿童急性B淋巴细胞白血病中的表达及其在微小残留病检测中的应用

目的:检测细胞表面抗原CD123在儿童急性B淋巴细胞白血病(B-lineage acute lymphoblastic leukemia,B-ALL)中的表达,并探讨其在儿童B-ALL微小残留病(minimal residual disease,MRD)检测中的应用及意义。方法:以健康儿童骨髓淋巴细胞为对照,应用多参数流式细胞术检测91例儿童B-ALL患者骨髓淋巴细胞免疫表型及CD123的表达,其中78例B-ALL患者进行了骨髓细胞染色体培养及细胞遗传学分析。用CD10/CD123/CD34/CD19等抗体组合对其中CD123阳性表达的65例B-ALL患者进行MRD标记的筛选和监测。结果:健康儿童骨髓淋巴细胞CD123为阴性表达,91例儿童B-ALL患者中65例骨髓淋巴细胞CD123阳性表达(阳性率71.43%),且表达水平与白血病细胞成熟度呈负相关,CD34高表达患儿CD123表达水平高于CD34低表达患儿;细胞遗传学分析超二倍体组患儿CD123表达水平高于非超二倍体组;筛选到47例(占51.65%)B-ALL患儿CD123高表达。结论:儿童B-ALL患者多数表达CD123,表达水平与细胞成熟度呈负相关,CD123可用作B-ALL患儿的MRD监测标记。     

Immunophenotype of myeloid cells in myelodysplastic syndromes and its clinical implications.

OBJECTIVE: To explore the immunophenotype of myeloid cells in myelodysplastic syndyomes (MDS) and its clinical implications. METHODS: A panel of monoclonal antibody was used to detect CD13+, CD33+, CD15+ and CD14+ antigens on the membrane surfaces of myeloid cells in the bone marrow from 51 MDS, 21 aplastic anemia (AA), 21 paroxysmal nocturnal hemoglobinuria (PNH) patients. 10 acute myeloblastic leukemia (AML) patients and 15 normal subjects by immunoenzymatic assay. The morphology and chromosome karyotype of bone marrow cells of MDS patients were also examined. RESULTS: CD14+, CD13+ and CD33+ cells in the bone marrow were more in MDS patients than in normal controls, AA patients and PNH patients. CD15+ cells in the bone marrow were less in MDS patients than in normal controls. CONCLUSIONS: The percentages of CD14+, CD13+ and CD33+ positive cells in the bone marrow of MDS patients were related to the percentage of myeloblasts, the chromosomal aberrations and the response to treatment. It indicated that there is immunophenotypic misexpression of myeloid cells in MDS patients. Immunophenotype analysis of myeloid cells might be useful for the diagnosis and treatment of MDS patients.     

fas介导系统性红斑狼疮患者Foxp3+CD4+CD25+Treg细胞凋亡的研究

目的 探讨fas凋亡信号传导途径在系统性红斑狼疮(SLE)患者Foxp3+CD4+CD25+Treg凋亡异常中的作用.方法 选取活动期SLE患者25例、缓解期SLE患者20例及健康对照25名为研究对象,检测所有研究对象外周血Foxp3+CD4+CD25+Treg表面fas的表达,同时分析CD4+CD25+T细胞Foxp3表达.并分别将fas表达率及Foxp3表达率与病情活动性(SLEDAI评分)进行相关分析.结果 (1)外周血Foxp3+CD4+CD25+Treg上fas的表达:活动期SLE组为(23.72±2.35)%,缓解期SLE组为(14.0±2.1)%,对照组为(10.1±1.2)%,在活动期SLE组明显高于缓解期SLE组(P＜0.01)和对照组(P＜0.01),而缓解期SLE组与对照组差异无统计学意义(P＞0.05),fas在Foxp3+CD4+CD25+Treg上的表达与SLEDAI评分呈正相关(r=0.336,P＜0.05).(2)外周血CD4+CD25+T细胞Foxp3的表达:活动期SLE组为(2.83±0.30)%,缓解期SLE组为(5.38±0.63)%,对照组为(8.12-±0.70)%.活动期SLE组外周血 CD4+CD25+T细胞Foxp3表达明显低于缓解期SLE组(P＜0.01)和对照组(P＜0.01);而缓解期SLE组亦低于对照组(P＜0.05).外周血Foxp3表达与SLEDAI评分呈负相关(r=-0.581,P＜0.01).(3)Foxp3与fas的表达呈负相关(r=-0.349,P＜0.01).结论 SLE患者中存在由fas介导的Foxp3+CD4+CD25+Treg的过度凋亡,这可能是导致SLE病情活动的机制之一.

Abstract：

Objective To explore the role of fas apoptosis signal transduction pathway in the abnormal apoptosis of Foxp3 + CD4 + CD25 + Treg in patients with systemic lupus erythematosus ( SLE ).Methods Twenty-five active SLE patients, 20 remission SLE patients and 25 controls were selected. The level of fas expression on peripheral blood Foxp3 + CD4 + CD25 + Treg surface was detected in SLE patients.And analyzed the expression rate of Foxp3 on CD4 + CD25 + T cells was analyzed to explore the relationship between the expression rate and disease activity. Results ( 1 ) The expression rate of fas on Foxp3 + CD4 +CD25 + Treg was (23.72 ± 2. 35 )% , ( 14. 0 ± 2. 1 )% in active and remission SLE groups respectively versus ( 10. 1 ± 1.2)% in control group. The fas expression rate of active SLE group was significantly higher than those of remission SLE group( P ＜ 0. 01 ) and control group ( P ＜ 0. 01 ). And the remission SLE and control groups were not statistically significant ( P ＞0. 05 ). The expression rate of fas on the Foxp3 + CD4 +CD25 + Treg was positively correlated with the SLEDAI ( SLE disease activity index ) score ( r = 0. 336, P ＜0.05). (2) The expression rate of Foxp3 on CD4 +CD25 +T cells was (2.83 ±0.30)%, (5.38 ±0. 63 ) % in active and remission SLE groups respectively versus ( 8. 12 ± 0. 70 ) % in control group. The expression rate of Foxp3 was significantly lower in active SLE group than that in remission SLE group ( P ＜0. 01 )and control group( P ＜0. 01 ). And the Foxp3 expression rate of remission group was also lower than that of control group ( P ＜ 0.05 ). The expression rate of Foxp3 was negatively correlated with the SLEDAI score (r = -0. 581, P ＜ 0. 01 ). (3) The expression rate of Foxp3 was negatively correlated with fas (r=- 0. 349, P ＜ 0. 01 ). Conclusion The abnormal apoptosis of Foxp3 + CD4 + CD25 + Treg mediated by the fas apoptosis signal transduction pathway may be one of the pathogenic mechanisms of disease activity in SLE patients.     

慢性乙型肝炎患者CD4+ CD25+调节性T细胞免疫抑制功能的研究

目的 探讨慢性乙型肝炎患者CD4+ CD25+调节性T细胞(Treg)免疫抑制功能.方法 收集北京大学人民医院22例慢性乙型肝炎(CHB)患者外周血单个核细胞(PBMC)以及18名健康对照的PBMC标本,以流式分析对PBMC中CD4+ CD25+ Treg的频率进行分析;5-溴脱氧尿嘧啶核苷(BrdU)掺入法评价CD4+ CD25+ Treg的免疫抑制功能;并同时通过磁珠分选去除CHB患者PBMC中的CD4+ CD25+ Treg,分别以MHC-肽-五聚体法和酶联斑点免疫法(Elispot)检测HBVcore18-27抗原肽刺激对HBV特异性的细胞毒性T淋巴细胞(CTLs)的频率以及IFN-γ的分泌.结果 CHB患者外周血中CD4+ CD25+ Treg细胞群所占CD4+T细胞群的比例明显高于健康对照(t=3.74,P＜0.01);CHB患者CD4+ CD25+ Treg细胞可非特异抑制自身活化的CD4+ CD25- T细胞,并呈剂量依赖的特点,且抑制能力与健康对照相比无明显差异;在经HBVcore18-27抗原肽诱导条件下,去除CD4+ CD25+ Treg CHB患者,HBVcore18-27特异性CTLs的频率以及CTLs分泌IFN-γ的频数与未去除CD4+ CD25+ Treg组比出现显著上调(t=4.75,t=7.828,P＜0.01).结论 CHB患者循环中CD4+ CD25+ Treg细胞频率升高.在体外去除CHB患者PBMC的CD4+ CD25+ Treg后可显著地增强HBV抗原诱导的抗HBV细胞免疫应答.