再生障碍性贫血患者细胞免疫功能与造血细胞因子的研究

目的：进一步探讨再生障碍性贫血（再障）的免疫发病机制，阐明细胞免疫、造血细胞因子在再障患者中发生变化的基础与临床意义。方法：用单抗试剂盒，采用改良ＡＰＡＡＰ法及酶联免疫试剂盒，采用ＥＬＩＳＡ法对３８例再障患者及２０名正常人外周血Ｔ细胞亚群，ＨＬＡ－ＤＲ抗原表达以及外周血单个核细胞（ＰＢＭＮＣ）培养上清诱生Ｇ－ＣＳＦ、ＩＬ－６、ＴＮＦα、ＩＦＮα及ＩＬ－８水平进行测定。结果：再障患者外周血ＣＤ４细胞减低、ＣＤ８细胞增高、ＣＤ４／ＣＤ８降低或倒置，ＨＬＡ－ＤＲ抗原表达率增高。再障患者ＰＢＭＮＣ培养上清中Ｇ－ＣＳＦ阳性率减低，ＩＬ－６、ＴＮＦα、ＩＦＮα及ＩＬ－８水平增高。相关分析发现Ｇ－ＣＳＦ与ＣＤ４细胞及ＣＤ４／ＣＤ８呈正相关，而与ＩＦＮα呈负相关；ＩＬ－６与白细胞数及ＣＤ４细胞呈负相关；ＴＮＦα与ＣＤ８细胞呈正相关而与ＣＤ４／ＣＤ８呈负相关；ＩＬ－８与ＣＤ８细胞及ＨＬＡ－ＤＲ呈正相关。结论：细胞免疫功能异常及细胞因子网络失调在再障发病中起一定的作用。

Study on the cellular immune function and cytokines in aplastic anemia patients

OBJECTIVE: To evaluate the effects of cellular immune function and cytokines on the pathogenesis of aplastic anemia (AA) and its clinical significance. METHODS: T lymphocyte subsets and HLA-DR antigen expression in the peripheral blood cells were assayed, and the levels of G-CSF, IL-6, TNF alpha, IFN alpha and IL-8 in the PBMNC culture supernatants were determined in 38 AA patients and 20 normal control with APAAP and ELISA methods. RESULTS: CD4+ cells, CD4+/CD8+ cells and G-CSF level were lower, and CD8+ cells, HLA-DR+ cells and IL-6, TNF alpha, IFN alpha and IL-8 levels were higher in AA patients than in normal controls. The level of G-CSF was positively correlated with CD4+ cells and CD4+/CD8+ cells and negatively with IFN alpha level. IL-6 level was negatively correlated with WBC count and CD4+ cells. TNF alpha level was positively correlated with CD8+ cells and negatively with CD4+/CD8+ cells. IL-8 level was positively correlated with CD8+ cells and HLA-DR+ cells. CONCLUSION: The cellular immune dysfunction and cytokine aberration participate in the pathogenesis of AA.