血管免疫母细胞性T细胞淋巴瘤患者外周血淋巴细胞亚群检测的临床意义

目的 分析血管免疫母细胞性T细胞淋巴瘤(AITL)患者诊断时外周血淋巴细胞亚群与临床预后的相关性及其化疗后的动态变化。方法 回顾性分析2016年3月至2021年9月就诊于苏州大学附属第三医院的16例初治AITL患者的临床资料,以同期10例健康人群的淋巴细胞亚群结果为对照组。采用Kaplan-Meier法及COX回归模型进行生存分析。采用ROC曲线计算CD4/CD8临界值,并将患者分为低CD4/CD8组和高CD4/CD8组。结果 与对照组相比,AITL患者诊断时外周血中CD3⁺T细胞、CD4⁺T细胞、CD3⁺CD25⁺活化T细胞计数及CD4/CD8比值明显降低;同时,CD19⁺B细胞、CD20⁺B细胞、CD5⁺CD19⁺及CD19⁺CD23⁺活化B细胞计数皆明显降低。在第一疗程化疗后,患者CD3⁺T细胞比例较初诊时明显升高,在完成3疗程治疗后,CD4⁺T细胞比例、CD3⁺CD25⁺活化T细胞比例及CD4/CD8比值明显升高。生存分析显示低CD4/CD8组无进展生存时间(PFS)及总生存期(OS)均明显优于高CD4/CD8组。结论 AITL患者初诊时外周血中高CD4/CD8比值与临床不良预后相关。与健康人群相比,AITL患者外周血CD4⁺ T细胞计数明显降低,且在有效治疗后可部分恢复。通过对AITL患者淋巴细胞亚群的分析,能够为识别AITL新的预后标志及实施有效的个体化免疫治疗提供新的思路。

Clinical determination of lymphocyte subsets in peripheral blood of patients with angioimmunoblastic T cell lymphoma

Objective To analyze the relevance between lymphocyte subsets and clinical prognosis in the peripheral blood of patients with angioimmunoblastic T cell lymphoma (AITL) during diagnosis, and to assess their dynamic changes after chemotherapy.M-ethods The clinical data of 16 initial AITL patients (treatment group) and 10 lymphocyte subsets (control group) were retrospectively analyzed, these patients visited the Third Affiliated Hospital of Soochow University between March 2016 and September 2021. Kaplan-Meier method and Cox regression were adopted for survival analysis. Receiver Operator Characteristic (ROC)curve was used to calculate the cutoff value of CD4/CD8 ratio, and the patients of the treatment group were assigned into low and high CD4/CD8 groups. Results Compared to the controls, the absolute count of CD3⁺T cells, CD4⁺ T cells, CD3⁺CD25⁺ activated T cells and CD4/CD8 ratio significantly decreased in the peripheral blood of AITL patients at the initial diagnosis. Whereas, the absolute count of CD19⁺ B cells, CD20⁺ B cells, CD5⁺CD19⁺ and CD19⁺CD23⁺ activated B cell significantly decreased. The proportion of CD3⁺ T cells after the first course of chemotherapy significantly increased than that at the initial diagnosis, and the proportion of CD4⁺ T cells, CD3⁺CD25⁺ activated T cells and CD4/CD8 significantly increased after three courses of the treatment. The survival analysis showed that the progression-free-survival (PFS) and overall survival (OS) of the low CD4/CD8 group were significantly higher than those of the CD4/CD8 group. Conclusion High CD4/CD8 ratio in peripheral blood at the initial diagnosis of AITL patients is associated with poor prognosis. CD4⁺ T cell count in the peripheral blood of patients is significantly decreased compared with healthy people, and which can be partially recovered after effective treatment. The analysis on lymphocyte subsets in AITL supports providing new ideas for identifying new prognostic markers of AITL and implementing effective individualized immunotherapy.