本文選題：全血細胞減少 + 免疫相關(guān)�。� 參考：《天津醫(yī)科大學》2012年碩士論文

【摘要】：目的：研究免疫相關(guān)性全血細胞減少癥(immuno-related pancytopenia, IRP)患者外周血樹突狀細胞(dendritic cell, DC)數(shù)量和功能,探討DC在IRP發(fā)病中的作用。 方法：研究對象為65例IRP患者,其中初治患者(初治組)37例、經(jīng)免疫抑制及促造血治療后血象恢復正�；颊�(恢復組)28例、正常對照17名。采用流式細胞術(shù)(FCM)檢測IRP患者外周血mDC (myeloid dendritic cell) (Lin-HLA-DR+CD11c+細胞)、pDC (plasmacytoid dendritic cell)(Lin-HLA-DR+CD123+細胞)數(shù)量及其表面共刺激分子CD80、CD86的表達水平。分析mDC、pDC、pDC/mDC及mDC、pDC表面共刺激分子CD80、CD86的表達水平與Th1/Th2比例、CD19+/骨髓單個核細胞(BMMNC)比例、BMMNC抗體(IgG)數(shù)量及血象的相關(guān)性。 結(jié)果： 1、IRP初治組pDC占外周血單個核細胞(PBMNC)的比例為(0.91±0.64)%,明顯高于恢復組(0.39±0.11)%和正常對照組(0.29±0.13)%(p0.01,p0.01),恢復組明顯高于正常對照組(p0.05)；IRP初治細、恢復組外周血mDC占PBMNC的比例分別為(0.21±0.20)%、(0.34±0.21)%,與正常對照組(0.29±0.09)%比較均無統(tǒng)計學意義；IRP初治組pDC/mDC比值為6.75±6.11,明顯高于恢復組(1.55±0.93)和正常對照組(1.07±0.43)(p0.01,p0.01),恢復組與對照組比較沒有明顯差別(p0.05)。 2、IRP初治組外周血pDC表面CD80的表達水平為(6.31±4.49)%,明顯高于恢復組(3.09±2.93)%和正常對照組(2.33±2.25)%(p0.05,p0.05),而恢復組外周血pDC表面CD80的表達水平與正常對照組比較差異無統(tǒng)計學意義(p0.05);IRP初治組、恢復組外周血pDC表面CD86表達水平分別(82.47±13.17)%、(60.08±14.29)%,均明顯高于正常對照組(47.95±18.59)%(p0.05,p0.05),初治組外周血pDC表面CD86的表達水平明顯高于恢復組(p0.05)；IRP初治組、恢復組外周血mDC表面CD80表達水平分別為(6.20±5.44)%、(3.97±3.24)%,均明顯高于正常對照組(1.86±1.73)%(p0.05,p0.05),初治組與恢復組比較差異無統(tǒng)計學意義(p0.05)；IRP初治組外周血mDC表面CD86表達水平為(97.06±4.82)%、恢復組為(95.58±6.51)%、正常對照組為(91.35±12.2)%,初治組明顯高于正常對照組(p0.05)。 3、IRP組外周血pDC占PBMNC的比例與Th1/Th2呈負相關(guān)(r=-0.347,p0.05),與BMMNC抗體(IgG)數(shù)量呈正相關(guān)(r=0.606,p0.05),與CD19+/BMMNC呈正相關(guān)(r=0.709,p0.05),與血紅蛋白和血小板水平均呈負相關(guān)(r=-0.381,p0.01)(r=-0.343,p0.01)；mDC占PBMNC的比例與Th1/Th2呈正相關(guān)(r=0.595,p0.05),與血紅蛋白水平呈正相關(guān)(r=0.292,p0.05)；pDC/mDC與Th1/Th2水平呈負相關(guān)(r=-0.395,p0.05)與BMMNC抗體(IgG)數(shù)量呈正相關(guān)(r=0.421,p0.05),與CD19+/BMMNC呈正相關(guān)(r=0.423,p0.05),與血紅蛋白和血小板水平均呈負相關(guān)(r=-0.304,p0.05)(r=-0.287,p0.05)；IRP組外周血pDC表面共刺激分子CD80表達水平與血紅蛋白、血小板呈負相關(guān)(r=-0.431,p0.05)(r=-0.464,p0.05)；CD86表達水平與Th1/Th2呈負相關(guān)(r=-0.733,p0.05),與BMMNC抗體(IgG)數(shù)量呈正相關(guān)(r=0.283,p0.05),與CD19+/BMMNC呈正相關(guān)(r=0.,436,p0.05),與血紅蛋白、血小板、白細胞水平均呈負相關(guān)(r=-0.539：p0.05)(r=-0.519,p0.05)(r=-0.567,p0.05)；IRP組外周血mDC表面共刺激分子CD80表達水平與血紅蛋白和白細胞水平呈負相關(guān)(r=-0.262,p0.05)(r=-0.31,p0.05);CD86表達水平與白細胞水平呈負相關(guān)(r=-0.245,p0.05)。 結(jié)論：pDC在IRP患者中數(shù)量增加,功能亢進,且數(shù)量與功能狀態(tài)的變化具有一致性,隨著治療有效,逐漸趨于正常。pDC在IRP免疫發(fā)病機制中可能發(fā)揮重要作用,有可能成為該疾病潛在的治療靶點。
[Abstract]:Objective : To study the number and function of dendritic cell ( DC ) in peripheral blood mononuclear cells ( DCs ) in patients with immune - related panhematopenia ( IRPs ) , and to explore the role of DC in the pathogenesis of IRPs .

Methods : Sixty - five patients with IRPs were studied , including 37 patients with primary treatment ( initial treatment group ) , 28 patients with normal control group ( recovery group ) , 28 normal controls , and 17 normal controls after immunosuppressive therapy and hematopoietic treatment . The peripheral blood mDC ( DCs ) of patients with IRPs was detected by flow cytometry ( FCM ) .

The expression levels of CD80 and CD80 on the surface of mDC , pDC , pDC / mDC and mDC , pDC , pDC , pDC / mDC and mDC , pDC were analyzed . The expression levels of CD80 and CD80 on the surface of mDC , pDC , pDC / mDC and mDC , pDC were compared with those of the Th1 / Th2 ratio , the proportion of CD19 + / bone marrow mononuclear cells ( BMMNC ) , the number of BMMNC antibodies ( IgG ) and the blood image .

Results :

1 . The proportion of pDC in peripheral blood mononuclear cells ( PBMNC ) was ( 0.91 鹵 0.64 ) % , significantly higher than that in the recovery group ( 0.39 鹵 0.11 ) % and the normal control group ( 0.29 鹵 0.13 ) % ( P 0.01 , p0.01 ) .
The proportion of mDC in peripheral blood of recovery group was ( 0.21 鹵 0.20 ) % , ( 0.34 鹵 0.21 ) % , compared with normal control group ( 0.29 鹵 0.09 ) % , respectively .
The pDC / mDC ratio of the initial treatment group was 6.75 鹵 6.11 , which was significantly higher than that in the recovery group ( 1.55 鹵 0.93 ) and the normal control group ( 1.07 鹵 0.43 ) ( p0.01 , p0.01 ) . There was no significant difference between the recovery group and the control group ( p < 0.05 ) .

2 . The expression level of CD80 on peripheral blood pDC was ( 6.31 鹵 4.49 ) % , significantly higher than that in the normal control group ( 3.09 鹵 2.93 ) % and the normal control group ( 2.33 鹵 2.25 ) % ( P < 0.05 ) .
The level of CD80 expression in peripheral blood of recovery group was ( 6.20 鹵 5.44 ) % , ( 3.97 鹵 3.24 ) % , ( 3.97 鹵 3.24 ) % and ( 3.97 鹵 3.24 ) % , respectively .
The expression level of CDDCs in peripheral blood was ( 97.06 鹵 4.82 ) % , ( 95.58 鹵 6.51 ) % , ( 91.35 鹵 12.2 ) % in the normal control group and ( 91.35 鹵 12.2 ) % in the normal control group .

3 . The proportion of peripheral blood pDC to PBMNC was negatively correlated with Th1 / Th2 ( r = - 0.347 , p0.05 ) , positively correlated with the quantity of BMMNC antibody ( IgG ) ( r = 0.709 , p0.01 ) ( r = - 0.381 , p0.01 ) ( r = - 0.343 , p0.01 ) .
The ratio of mDC to PBMNC was positively correlated with Th1 / Th2 ( r = 0.595 , p0.05 ) and positively correlated with hemoglobin level ( r = 0.292 , p0.05 ) .
There was a negative correlation between the levels of pDC / mDC and Th1 / Th2 ( r = - 0.395 , p0.05 ) and the number of BMMNC antibodies ( IgG ) ( r = 0.421 , p0.05 ) , which was positively correlated with the levels of CD 19 + / BMMNC ( r = 0.423 , p0.05 ) ( r = - 0.304 , p0.05 ) ( r = - 0.287 , p0.05 ) ;
The level of CD80 expression was negatively correlated with hemoglobin and platelet ( r = - 0.441 , p0.05 ) ( r = - 0.464 , p0.05 ) .
There was a negative correlation ( r = - 0.733 , p . 05 ) between the expression level and Th1 / Th2 ( r = - 0.733 , p0.05 ) , which was positively correlated with the number of BMMNC ( r = 0.283 , p0.05 ) ( r = - 0.519 , p0.05 ) ( r = - 0.519 , p0.05 ) ( r = - 0.567 , p0.05 ) .
The level of CD80 expression was negatively correlated with the level of hemoglobin and white blood cells ( r = - 0.262 , p0.05 ) ( r = - 0.31 , p < 0.05 ) . The expression level of CD80 was negatively correlated with leukocyte level ( r = - 0.245 , p0.05 ) .

Conclusion : The quantity of pDC is increased in patients with IRPs , and the quantity is consistent with the change of functional state . As the therapy is effective , it gradually tends to be normal . pDC may play an important role in the pathogenesis of IRPs , and it is possible to be a potential therapeutic target for the disease .

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R392

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