本文選題：重癥肌無力　切入點：免疫耐受　出處：《中南大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：探討濾泡調節(jié)性T細胞在重癥肌無力(MG)發(fā)病中的作用。 方法：收集2013年一2014年湘雅醫(yī)院門診及病房MG患者,并詳細記錄其臨床資料。根據(jù)MG患者疾病的嚴重程度,進行臨床MGFA分型及QMG評分。采用流式細胞術檢測MG患者及健康對照人群外周血濾泡調節(jié)性T細胞(Tfr)、天然調節(jié)性T細胞(Treg)及濾泡輔助性T細胞(Tfh)的表達比例,并分析其與臨床特征、疾病嚴重程度的關系及免疫治療前后的變化。 結果：(1)MG患者外周血中Treg細胞的表達較健康人群降低,Tfh細胞的表達增高,Tfr細胞的表達降低,Tfr/Treg及Tfr/Tfh降低,差異均具有統(tǒng)計學意義(P0.05) (2)全身型MG患者外周血中Treg細胞的表達比例高于眼肌型MG患者,Tfh細胞的表達低于眼肌型MG患者,Tfr/Tfh低于眼肌型MG患者,但差異均無統(tǒng)計學意義(P0.05)。與眼肌型MG相比,全身型MG患者Tfr細胞的表達降低,Tfr/Treg降低,差異具有統(tǒng)計學意義(P0.05)。按照MGFA分型的各亞型MG患者中Treg、Tfr、Tfh細胞的表達無明顯差異(P0.05)。 (3) Tfr、Treg、Tfh在不同年齡、性別的MG患者外周血中的表達均無顯著性差異(P0.05)。與病程小于1年的MG患者相比,病程大于1年的MG患者,Treg、Tfh的表達無顯著性差異,而Tfr細胞的表達降低,Tfr/Treg及Tfr/Tfh值減小,差異具有統(tǒng)計學意義(P0.05) (4) Treg、Tfr、Tfh在胸腺正常與胸腺瘤及胸腺增生組的表達水平無顯著差異。 (5)與非激素治療組相比,激素治療組MG患者外周血中Treg細胞的表達增高,Tfh細胞的表達降低,Tfr細胞的表達增高,Tfr/Tfh的比值增高,差異均具有統(tǒng)計學意義(P0.05)。激素治療自身前后對比發(fā)現(xiàn),激素治療后外周血中Treg細胞的表達較治療前增加,Tfh細胞的表達降低,Tfr細胞的表達增高,差異具有統(tǒng)計學意義(P0.05)。 (6)MG患者QMG評分與外周血中Treg細胞的表達呈負相關,與Tfh細胞的表達呈正相關,與Tfr細胞的表達呈負相關,與Tfr/Treg及Tfr/Tfh均呈負相關,相關系數(shù)分別為-0.3840、0.4284、0.5450、-0.3839、-0.6359,有統(tǒng)計學意義(p0.05)。 (7)MG患者外周血中Tfr與Tfh細胞的表達水平無明顯相關性,Tfr與Treg細胞存在正相關,相關系數(shù)為0.4318,有統(tǒng)計學意義(p0.001)。 結論：濾泡調節(jié)性T細胞在重癥肌無力的發(fā)病中具有負性免疫調控作用,其作用可能與天然調節(jié)性T細胞、濾泡輔助性T細胞具有一定相關性。
[Abstract]:Objective: to investigate the role of follicular regulatory T cells in the pathogenesis of myasthenia gravis (MG). Methods: the patients with MG in outpatient and ward of Xiangya Hospital from 2013 to 2014 were collected and their clinical data were recorded in detail. Clinical MGFA typing and QMG score were used to detect the expression rate of T cells in peripheral blood follicular regulatory T cells, natural regulatory T cells and follicular helper T cells by flow cytometry in patients with MG and healthy controls. The relationship between the disease and the clinical features, the severity of the disease and the changes before and after immunotherapy were analyzed. Results the expression of Treg cells in the peripheral blood of the patients with MG was significantly lower than that of the healthy controls. The expression of Tfr cells was lower than that of the healthy controls. The expression of Tfr cells was significantly lower than that of the normal controls. There was a significant difference in the expression of Tfr cells and the expression of Tfr cells (P 0.05). (2) the expression of Treg cells in peripheral blood of patients with systemic MG was higher than that of patients with myometrial MG, and the expression of Tfh cells was lower than that of patients with myometric MG, but there was no significant difference in the expression of Tfh and Tfh in patients with myometrial MG, but there was no significant difference in the expression of Tfh cells between patients with myometric MG and those with myometric MG. The expression of Tfr cells was decreased in patients with systemic MG, and the difference was statistically significant (P 0.05). There was no significant difference in the expression of Tfr-Tfr-Tfh cells in all subtypes of MG according to MGFA classification. (3) there was no significant difference in the expression of Tfh in the peripheral blood of MG patients with different age and sex. There was no significant difference in the expression of TregTfh in MG patients with more than 1 year course compared with MG patients with less than one year course. However, the expression of TRF / Treg and Tfr/Tfh in Tfr cells decreased, and the difference was statistically significant (P 0.05). 4) there was no significant difference in the expression of Tfh between normal thymus and thymoma and thymic hyperplasia. (5) compared with the control group, the expression of Treg cells in the peripheral blood of MG patients was increased and the expression of Tfh cells was decreased in the hormone treated group, and the ratio of Tfr / Tfh was increased. The difference was statistically significant (P 0.05). The expression of Treg cells in peripheral blood after hormone therapy was significantly lower than that before and after treatment, and the difference was statistically significant (P 0.05). The QMG score was negatively correlated with the expression of Treg cells in peripheral blood, positively with the expression of Tfh cells, negatively with the expression of Tfr cells, and negatively with Tfr/Treg and Tfr/Tfh. The correlation coefficients were -0.3840, 0.4284- 0.5450- 0.3839-0.3839-0.6359, respectively. There was no significant correlation between the expression of Tfr and Tfh cells in the peripheral blood of patients with MG. There was a positive correlation between Tfr and Treg cells, and the correlation coefficient was 0.4318, which was statistically significant (P 0.001). Conclusion: follicular regulatory T cells play a negative role in the pathogenesis of myasthenia gravis, which may be related to natural regulatory T cells and follicular helper T cells.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R746.1

【共引文獻】

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本文編號：1604206