苯中毒再生障碍性贫血患者骨髓细胞免疫功能和Fas、CD34抗原变化

目的　探讨细胞免疫功能、Fas和CD3 4抗原与苯中毒再生障碍性贫血发生、发展及转归的关系。方法　用流式细胞仪检测2 4例苯中毒再障(BPAA)和16例无苯制剂接触史的再障(AA)患者治疗前后骨髓单个核细胞Fas、CD3 4的表达率和T细胞亚群变化。结果　苯中毒再生障碍性贫血和再障患者骨髓单个核细胞Fas表达率显著增高(P <0 . 0 0 1) ,CD3 4阳性率明显降低(P <0 . 0 0 1) ;CD3 + CD8+ T淋巴细胞明显升高(P <0 . 0 5 ) ,CD4+ /CD8+ 比值明显降低(P <0 . 0 0 1) ;治疗缓解后Fas、CD3 4阳性率、CD3 + CD8+ T淋巴细胞和CD4+ /CD8+ 比值趋于正常(P >0 . 0 5 )。但在AA组Fas、CD3 4阳性率和CD4+ /CD8+ 比值较正常对照组差异仍有显著性。两组再障患者之间比较差异无显著性。结论　细胞免疫功能紊乱、Fas抗原的异常表达和CD3 4+ 干/祖细胞损伤,可能与苯中毒再生障碍性贫血病理发病机制有关,用环孢霉素A治疗可能有效。

Alteration of Fas and CD34 antigen expression and cellular immune function in patients with aplastic anemia caused by benzene poisoning

Objective To explore the relationship of the expression of Fas and CD34 antigen and cellular immune function with occurrence,progress,prognosis,outcome and pathological mechanism of benzene poisoning aplastic anemia(BPAA).Method The expression rates of Fas and CD34 antigen in marrow mononuclear cells(MNC)and changes in T-lymphocyte subsets were determined by flow cytometry in 24 patients with BPAA and 16 with AA unexposed to benzene before and after therapy,as well as in 15 healthy controls.Result The expression rate of Fas antigen was significantly higher in patients with BPAA and AA than that in controls(P<0.05),whereas that of CD34 antigen was significantly lower(P<0.001).Counts of CD3+ and CD8+ T-cells increased significantly in patients with BPAA and AA(P<0.05),with a significantly decreasing ratio of CD4+/CD8+(P<0.001),compared with those in healthy controls.After remission with therapy,the expression rates of Fas and CD34 antigen,counts of CD3+ and CD8+ and ratio of CD4+/CD8+ were restored to normal in patients with BPAA(P>0.05),whereas the expression rates of Fas and CD34 antigen and ratio of CD4+/CD8+ in patients with AA still differed significantly from healthy controls.There was no significant difference in those indicators between patients with BPAA and with AA.Conclusion Disturbance of cellular immune function,abnormal expression of Fas antigen and damage in CD34+ stem/progenitor cells presumedly related to pathological mechanism of BPAA.Cyclosporine A may be effective in therapy of BPAA.