再生障碍性贫血选用免疫抑制剂或雄激素治疗预测指标的初步研究

目的 研究和评价以外周血T细胞亚群、Th1/Th2、T-bet和GATA-3基因表达及中西医诊断标准为主建立的多变量指标，作为再生障碍性贫血（AA）患者选用免疫抑制剂或雄激素的预测指标。方法 采用流式细胞术检测85例AA患者治疗前后外周血T细胞亚群, 同时运用实时定量PCR技术检测T-bet和GATA-3基因表达, 并以免疫抑制剂和雄激素有效病例做Logistic回归方程及ROC曲线分析。 结果 （1）按SPSS的ROC曲线模型, 设定假阳性率为0.10, 取P值为0.832, 若P值≥0.832时, 判定患者为免疫紊乱状态, 应加用免疫抑制疗法（IST）治疗；若P值< 0.832时, 判定患者为骨髓衰竭状态, 应加用雄激素治疗。（2）提出AA在疾病发生发展过程中可大致分为以异常免疫为主和以骨髓衰竭为主两个阶段, 以异常免疫为主应加用IST治疗；以骨髓衰竭为主应加用雄激素治疗。 结论 上述预测方法可判断AA患者处于以异常免疫为主或以骨髓衰竭为主状态, 指导免疫抑制剂或雄激素的临床应用。

Preliminary Study on Predictors for Selection of Immunosuppressive Therapy or Androgens in Treating Aplastic Anemia Patients

Objective To evaluate the potential usefulness of a multivariable model,established mainly upon peripheral T-cell subsets,Th1/Th2,T-bet and GATA-3 gene expressions as well as TCM and Western medical diagnostic criteria,in predicting the selection of immunosuppressive therapy(IST) or androgens in treating patients with aplastic anemia(AA).MethodsPeripheral blood T cell subsets in 85 patients with AA were serially analyzed by flow cytometry before and after treatment,and their T-bet and GATA-3 gene expression...