沙利度胺对多发性骨髓瘤患者CD4^＋CD25^＋调节性T细胞作用的临床研究

本研究探讨沙利度胺治疗前后多发性骨髓瘤（MM）患者CD4^＋CD25^＋调节性T细胞的比例及变化规律，为有效的免疫治疗提供理论依据。采用流式细胞术检测MM患者外周血CD3、CD4、CD8、NK及CD4^＋CD25^＋Treg细胞的比例；采用成组设计的两样本均数比较的t检验进行统计学分析，以P〈0．05为检验水准。结果表明：MM患者治疗前CD4^＋CD25^＋highT比例较正常人明显升高（P〉0．01），沙利度胺治疗有效患者的CD4^＋CD25^＋highT比例较治疗前明显降低（P〈0．01），治疗无效者Treg比例无显著变化（P〉0．05）。16例经化疗完全缓解，CD4^＋CD25^＋highT比例为6．91±1．12％，较治疗前升高，但无显著性差异（P〉0．05）。沙利度胺治疗有效者CD3^＋T、CD4^＋T、NK细胞比例及CD4／CD8比值较治疗前明显升高（P〉0．05或0．01），CD8^＋T治疗前后无显著变化（P〉0．05）。结论：CD4^＋CD25^＋Treg细胞的免疫抑制作用可能是MM免疫逃逸的重要机制，下调MM患者CD4^＋CD25^＋Treg可能是沙利度胺治疗MM有效的机制之一。

Effects of Thalidomide on CD4+ CD25+T Regulatory Cells in Patients with Multiple Myeloma

The study was purposed to explore the changes of CD4(+)CD25(+) T regulatory cells in patients with multiple myeloma before and (MM) after treatment with thalidomide so as to provide evidences for effective immunotherapy. The population of CD3(+) T, CD4(+) T, CD8(+) T, NK and CD4(+)CD25(+) Treg in patients with MM were detected by flow cytometry. Statistical significance of differences in different groups was determined by using the t test. A p value of less than 0.05 was considered to be significant. The results showed that the percentage of CD4(+)CD25(+ high) T in patients with MM was significantly higher than that of the healthy donors (p > 0.01). The population of CD4(+)CD25(+ high) Treg cells in patients with response to thalidomide was significantly decreased (p < 0.01), but the population of these cells in patients without response not changed significantly (p > 0.05), as compared with patients before treatment. In 16 patients who achieved complete remission after chemotherapy, the population of CD4(+)CD25(+ high) T was 6.91 +/- 1.12%, which was slightly higher than that before treatment. The population of CD3(+) T, CD4(+) T, CD8(+) T, NK and CD4(+)CD25(+) Treg significantly increased in patients with positive response to thalidomide, but the population of CD8(+) T remained unchanged. It is concluded that the significant increase of CD4(+)CD25(+) regulatory T cells in peripheral blood of patients with MM is concerned with the MM pathogenesis; thalidomide may exert its anti-MM effects by down-regulating CD4(+)CD25(+) Treg.