Objective: To investigate the distribution of bone marrow lymphocyte subsets in patients with myelodysplastic syndrome(MDS),the proportion of activated T cells with immunophenotype CD3+HLA-DR+ in the lymphocytes and its clinical significance, and to understand the effects of different types of MDS, different immunophenotypes, and different expression levels of WT1 on the proportion of lymphocyte subsets and activated T cells.
Methods: The immunophenotypes of 96 MDS patients, the subsets of bone marrow lymphocytes and activated T cells were detected by flow cytometry. The relative expression of WT1 was detected by real-time fluorescent quantitative PCR, and the first induced remission rate (CR1) was calculated, the differences of lymphocyte subsets and activated T cells in MDS patients with different immunophenotype, different WT1 expression, and different course of disease were analyzed.
Results: The percentage of CD4+T lymphocyte in MDS-EB-2, IPSS high-risk, CD34+ cells >10%, and patients with CD34+CD7+ cell population and WT1 gene overexpression at intial diagnosis decreased significantly (P<0.05), and the percentage of NK cells and activated T cells increased significantly (P<0.05), but there was no significant difference in the ratio of B lymphocytes. Compared with the normal control group, the percentage of NK cells and activated T cells in IPSS-intermediate-2 group was significantly higher(P<0.05), but there was no significant difference in the percentage of CD3+T, CD4+T lymphocytes. The percentage of CD4+T cells in patients with complete remission after the first chemotherapy was significantly higher than in patients with incomplete remission(P<0.05), and the percentage of NK cells and activated T cells was significantly lower than that in patients with incomplete remission (P<0.05).
Conclusion: In MDS patients, the proportion of CD3+T and CD4+T lymphocytes decreased, and the proportion of activated T cells increased, indicating that the differentiation type of MDS is more primitive and the prognosis is worse.
题目: 活化T细胞及淋巴细胞亚群在MDS中的分布及意义.
目的: 探讨骨髓增生异常综合征（MDS）患者骨髓淋巴细胞亚群的分布及免疫表型为CD3+HLA-DR+的活化T细胞在淋巴细胞中的占比及其临床意义,了解不同类型的MDS及不同免疫表型、不同WT1的表达量对淋巴细胞亚群及活化T细胞比例的影响.
方法: 采用流式细胞术检测96例MDS的免疫表型，以及骨髓淋巴细胞亚群的分布和活化T细胞的表达。采用实时荧光定量PCR检测WT1的相对表达量，统计初次诱导缓解率（CR1）。分析MDS患者不同免疫表型、不同WT1表达量、不同病程情况中淋巴细胞亚群及活化T细胞比例的差异.
结果: 在MDS-EB-2、IPSS高危、CD34+细胞比例>10%,以及伴有CD34+CD7+细胞群、初诊时WT1基因高表达的MDS患者CD4+T比例明显下降（P＜0.05），NK细胞及活化T细胞比例明显升高（P＜0.05），但B淋巴细胞比例无明显差异。与正常对照组相比，IPSS中危-2组NK细胞及活化T细胞比例明显升高（P＜0.05），但CD3+及CD4+的T淋巴细胞比例无明显差异。与未完全缓解的患者相比，首次化疗后完全缓解的患者CD4+T细胞比例明显升高（P＜0.05），NK细胞比例及活化T细胞比例明显减低（P＜0.05）.
结论: MDS患者中CD3+T淋巴细胞比例减低、CD4+T淋巴细胞比例减低，活化T细胞比例升高提示MDS分化类型更原始，预后更差.
Keywords: WT1; activated T cells; lymphocyte subsets; myelodysplastic syndrome.