系统性红斑狼疮重症血小板减少患者血清对巨核祖细胞的影响

研究系统性红斑狼疮(SLE)合并重症血小板患者的血清对正常人巨核祖细胞增殖分化的影响。以12例SLE重症血小板减少患者为研究对象,12份正常骨髓单个核细胞,培养中分别加入患者血清或灭活补体的患者血清,免疫化学染色检测巨核细胞克隆形成单位(CFU-MK),流式细胞仪检测CD41+细胞数。结果是正常对照组骨髓CFU-MK集落数为(61.22±29.71)个/片,加入SLE重症血小板减少患者血清后减少为(29.44±23.35)个/片,P<0.05;加灭活补体血清后减少为(22.56±15.21)个/片,与正常对照相比P<0.05;灭活补体与否差异不显著,P>0.05。加入患者血清或灭活补体的血清后,CD41+细胞数由正常(2.30%±1.63%)分别减少为(1.15%±0.85%)和(1.07%±0.76%),与正常对照相比P<0.05;灭活补体与否差异不显著。SLE血小板正常但活动期病人的血清对正常人CFU-MK和CD41+细胞的生成均无显著抑制。提示SLE重症血小板减少患者血清能抑制正常人骨髓巨核祖细胞的增殖分化,这种抑制作用是非补体依赖性的。

Influence of sera of patients with systemic lupus erythematosus complicated with severe thrombocytopenia on the proliferation and differentiation of megakaryocytes

To study the suppressive effect of sera of patients with systemic lupus erythematosus(SLE) complicated with severe thrombocytopenia on the proliferation and differentiation of megakaryocytes in normal individuals, 12 patients with SLE complicated with severe thromocytopenia and 12 cases of SLE who had never thrombocytopenia but in the active phase of disease were included in this study. Bone marrow mononuclear cells from normal individuals were cultivated both in semi,solid and liquid culture systems in the presence of thrombopoietin(TPO). Then patient's sera or the complement,inactivated sera of patients were added to the culture system, and the colony forming unit,megakaryocytes(CFU,MK) were quantified by an indirect immunophosphatase alkaline labeling technique by using the anti,GP IIb/IIIa monoclonal antibody. The FITC,CD41+ cells were assayed by flow cytometry. It was found that the colony numbers of CFU,MK of normal individuals were 61.22±29.71 per 2.2×105 bone marrow mononucleated cells, while those after addition of patient's serum or the complement inactivated sera into the semi,solid culture system were 29.44±23.35 and 22.56±15.21 respectively, both showing a reduction of the patients, P<0.05. After addition of patient's sera or the complement inactivated sera of patients, the counts of CD41+ cells were 1.15%±0.85% and 1.07%±0.76% respectively, while that of the normal individuals was 2.30%±1.63%. The count of CD41+ cell was also reduced when sera were added into the liquid culture system as demonstrated by flow cytometry. These findings suggest that a novel complement,independent inhibitor that can suppress the formation of megakaryocyte progenitor may be present in the sera of SLE complicated with severethrombocytopenia. It is possible that auto,antibodies against megakarocyte precursor in sera may play an important role in the pathogenesis of dysmegakaryopoiesis in SLE complicated with severe thrombocytopenia.