骨髓单个核细胞Coombs试验(+)血细胞减少患者骨髓巨噬细胞数量及功能的研究

目的 探讨骨髓单个核细胞Coombs(BMMNC-Coombs)试验(+)血细胞减少患者骨髓巨噬细胞(Mφ)数量、功能及其临床意义.方法 采用流式细胞术(FACS)检测61例BMMNC-Coombs试验(+)血细胞减少患者、10例重型再生障碍性贫血(SAA)患者及13名正常对照骨髓Mφ(CD68或CD45阳性)数量并通过鸡红细胞(CRBC)吞噬试验检测Mφ功能,并分析其临床意义.结果 BMMNC.Coombs试验(+)血细胞减少患者其Mφ百分率、吞噬率及吞噬指数(0.57±0.30)%、(37.56±15.20)%和0.75±0.34]均高于SAA组(0.46±0.08)%、(28.26±10.46)%和0.59±0.39]及正常对照组(0.44±0.69)%、(25.63±14.75)%和0.55 ± 0.16](P<0.05);且Mφ百分率与Mφ吞噬率及吞噬指数均呈正相关(r=0.43,P<0.01;r=0.40,P<0.01).根据Mφ数量将患者分为A组(Mφ≥10.5%)和B组(Mφ<0.5%),A组34例患者中32例(94.12%)自身抗体为IgG型,B组27例患者中仅2例(7.41%)自身抗体为IgG型;A组患者Mφ的吞噬率和吞噬指数(46.62±13.38)%和0.91±0.36]显著高于B组患者(28.67±12.59)%和0.61 ± 0.30](P<0.05),而B组患者与AA及正常对照组相比差异无统计学意义(P>0.05).将34例自身抗体IgG型患者分为Mφ高(≥0.75%)、低水平(<0.75%)两组,Mφ低水平组25例患者骨髓均仪能榆测到一系细胞与IgG结合,Mφ高水平组9例患者中8例能检测到二系细胞结合IgG,1例骨髓三系细胞均结合有IgG;Mφ高水平组患者中Mφ的吞噬率及吞噬指数(60.22±12.51)%、1.23±0.23]显著高于Mφ低水平组(43.32±9.24)%、0.84±0.24](P<0.05);Mφ高水平组患者外周血红细胞、血红蛋白、血小板计数均显著低于Mφ低水平组(P<0.05);Mφ高水平组网织红细胞比例、胆红素水平及胸骨红系比例均显著高于Mφ低水平组(P<0.05).结论 IgG型BMMNC-Coombs试验(+)血细胞减少患者骨髓Mφ数量增多,功能增强;IgG A身抗体阴性的BMMNC-Coombs试验(+)血细胞减少患者多有lgM型自身抗体或冷抗体,其骨髓损伤过程无Mφ参与.

Study on quantity and function of bone marrow macrophages in patients with BMMNC-Coombs Test(+) pancytopenia

Objective To explore the quantity and function of bone marrow(BM) macrophages in patients with BMMNC-Coombs Test(+) pancytopenia(BCTP).Methods Sixty-one patients with BCTP,10 with severe aplastic anemia(SAA) and 13 normal controls were enrolled in this study.The quantity of BM macrophages was measured by FACS and their function was evaluated by phagocytosis test.Results The number of macrophages,phagocytosis ratio and index of cock' s red blood cells (CRBC) in BCTP patients were (0.57 ± 0.30) %,(37.56 ± 5.20) %,and 0.75 ± 0.34,respectively,being significantly higher than those in SAA group 0.46 ± 0.08) %,(28.26 ± 10.46) %,and in 0.59 ± 0.39]and in normal control 0.44 ± 0.69) % (25.63 ± 14.75) %,and 0.55 ± 0.16](P<0.05).The BCTP patients were classified into two subgroups according to the quantity of macrophages:Group A (Mφ≥0.5%,34 cases) and Group B (Mφ<0.5%,27 cases).There were 32 cases (94.12%) with BMMNC-IgG(+) in Group A and only 2 cases (7.41%) in Group B.There were significant differences in phagocytosis ratio and index of macrophages between Group A 46.62 ± 13.38) % and 0.91 ± 0.36]and Group B (28.67±12.59) % and 0.61±0.30](P<0.05),while no statistical differences between group B and other two control groups (P>0.05).Thirty-four BMMNC-IgG (+) patients were further divided into two subgroups:High level (HL) group ≥0.75%,9 cases(26.47%)]and low level (LL) group <0.75%,25 cases (73.53%)].Only one lineage of BMMNC-IgG could be detected in LL group.Among 9 patients in HL group,8(23.53%) had two lineages of BMMNC-IgG and 1 (2.94%) had three lineages.Phagocytosis ratio and index of macrophages were significantly higher in HL group (60.22 ± 12.51)% and 1.23 ± 0.23]than in LL group (43.32 ± 9.24) % and 0.84 ± 0.24](P<0.05).The level of peripheral blood (PB) RBC,HGB and PLT in HL group were significantly lower than in LL group(P<0.05),while the percentage of Ret,the level of TBIL and the ratio of erythroid of sternal BM in HL group were significantly higher than in LI,group (P<0.05).Conclusion More quantity and stronger function of macrophages are observed in BCTP patients with BMMNC-IgG(+).One of the mechanism of hematocytopenia might be that macrophages activated by lgG autoantibodies phogocytose hematopoietic cells in BM.Macrophages do not involve in damage process of BM in BCTP with IgM or cold autoantibodies.