本文選題：骨髓增生異常綜合征 + 巨噬細胞　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過檢測健康對照組及不同危險分組骨髓增生異常綜合征患者骨髓巨噬細胞占單個核細胞的比例,骨髓Ⅰ型巨噬細胞和Ⅱ型巨噬細胞比值,及Ⅰ型和Ⅱ型巨噬細胞表面抗原的表達,并且通過體外培養(yǎng)刺激Ⅰ型巨噬細胞,并檢測IL-1β及TNF-αm RNA表達,比較正常對照組及實驗組的不同,探究巨噬細胞在骨髓增生異常綜合征發(fā)病中的作用。背景:MDS是一組起源于造血干細胞的髓系克隆性疾病。該病的主要特點為全血細胞減少和高風(fēng)險向急性白血病轉(zhuǎn)化。普遍的發(fā)病高齡化(平均發(fā)病年齡在70-75歲)使得對MDS患者的管理更為復(fù)雜,與此同時還有伴隨的非血液系統(tǒng)的并發(fā)癥,以及老年患者對于某些高強度治療的耐受力較差。除此之外,對于進展為AML的患者,其標準治療的療效要低于初治AML患者。雖然近年來對MDS來的治療取得了一些進展,來那度胺、地西他濱、阿扎胞苷以及造血干細胞移植等治療方法延長了病人的生存期,但是MDS患者預(yù)后差、生存期短、缺乏有效治療手段的局面并沒有從根本上改變,貧血、出血、感染等并發(fā)癥明顯降低了患者的生存質(zhì)量,并可直接導(dǎo)致患者死亡。微環(huán)境的改變和免疫下調(diào)導(dǎo)致了這種分化異常。近年來,腫瘤微環(huán)境是腫瘤發(fā)病機制與治療的研究熱點之一。腫瘤微環(huán)境主要由細胞、信號分子、細胞外基質(zhì)、細胞因子等組成。目前國內(nèi)外學(xué)者認為,單獨的腫瘤細胞不會致病,而是通過“招募”正常的細胞,通過細胞間的相互作用,分泌抑制性細胞因子,從而抑制機體免疫細胞的殺傷功能等機制,形成有利于腫瘤細胞生長的微環(huán)境,以此來促進腫瘤的進展和轉(zhuǎn)移。近年來有研究發(fā)現(xiàn),巨噬細胞也是造血微環(huán)境的成分細胞,影響造血干細胞的遷移與定居。而在MDS中也發(fā)現(xiàn)有異常的單核細胞積累的現(xiàn)象,影響細胞的遷移。因此MDS骨髓巨噬細胞的異常,可能對MDS的致病起到一定的作用。巨噬細胞在極化為M2后,可通過多種途徑對抗腫瘤免疫產(chǎn)生抑制。研究認為TAMs為M2巨噬細胞。另一方面,研究發(fā)現(xiàn)TAMs能夠抑制NK細胞及CTL細胞的殺傷功能。TAMs表達HLA-C、HLA-E和HLA-G等膜結(jié)合分子能夠抑制NK細胞的激活。巨噬細胞同樣表達PD-1及CTAL-4的配體。PD-1及CTAL-4通常在活化的免疫效應(yīng)細胞(如B細胞、T細胞及NK細胞)高表達,激活后抑制T細胞的細胞毒作用,從而抑制機體的免疫。材料與方法:首先,我們應(yīng)用流式細胞術(shù)(Flow Cytometry,FCM)檢測38名MDS患者(LR-MDS患者15名,HR-MDS患者23名)和21名正常對照(normal control,NC)骨髓中以CD14標記的骨髓單核細胞比例及CD14的平均熒強度(MFI),進而以CD14+、CD68+標記巨噬細胞,檢測巨噬細胞占骨髓單核細胞及骨髓單個核細胞的比例;以CD64、CD40標記Ⅰ型巨噬細胞(M1),CD206、CD163標記為Ⅱ型巨噬細胞(M2),比較MDS組與正常對照組M1/M2的不同,以及巨噬細胞表面CD64、CD40、CD206、CD163表達的不同。然后,通過體外培養(yǎng)刺激MDS及正常對照組M1巨噬細胞,提取兩組M1巨噬細胞的m RNA,比較兩組巨噬細胞IL-1β及TNF-αm RNA表達的不同。結(jié)果:1、MDS組及正常對照組骨髓單核細胞差異1.1骨髓單核細胞比例正常對照組骨髓單核細胞比例為(2.11±0.93)%,MDS-低危組骨髓單核細胞比例為(1.96±1.53)%,MDS-高危組骨髓單核細胞比例為(3.66±3.38)%。正常對照組與低危組相比骨髓單核細胞比例差異無統(tǒng)計學(xué)意義;較高危組相比骨髓單核細胞比例降低,差異有統(tǒng)計學(xué)意義(p0.05)。高危組較低危組相比比例升高,差異有統(tǒng)計學(xué)意義(p0.05)。1.2 CD14平均熒光強度正常對照組骨髓單核細胞CD14平均熒光強度為639.05±359.78,MDS-低危組骨髓單核細胞CD14平均熒光強度為501.43±374.44,MDS-高危組骨髓單核細胞CD14平均熒光強度為458.26±306.72。正常對照組與低危組相比骨髓單核細胞CD14平均熒光強度差異無統(tǒng)計學(xué)意義;較高危組相比骨髓單核細胞CD14平均熒光強度升高,差異有統(tǒng)計學(xué)意義(p0.05)。高危組較低危組相比骨髓單核細胞CD14平均熒光強度差異無統(tǒng)計學(xué)意義。2、MDS組及正常對照組骨髓巨噬細胞細胞差異2.1骨髓M1、M2巨噬細胞占單核細胞比例正常對照組M1巨噬細胞占單核細胞比例為(6.41±7.09)%,MDS-低危組M1巨噬細胞占單核細胞比例為(8.08±10.31)%,MDS-高危組M2巨噬細胞占單核細胞比例為(7.80±9.41)%,三組之間相比差異均無統(tǒng)計學(xué)意義正常對照組M2巨噬細胞占單核細胞比例為(1.82±2.47)%,MDS-低危組M2巨噬細胞占單核細胞比例為(3.18±3.79)%,MDS-高危組M2巨噬細胞占單核細胞比例為(3.93±3.81)%,MDS-高危組較正常對照組相比M2巨噬細胞占單核細胞比例明顯升高,且差異有統(tǒng)計學(xué)意義(p0.05)2.2骨髓M1巨噬細胞/M2巨噬細胞比值正常對照組骨髓M1/M2為3.50±3.22,MDS-低危組骨髓M1/M2為1.68±0.78,MDS-高危組骨髓M1/M2為1.80±0.88,正常組骨髓M1/M2與MDS-低危組及MDS-高危組骨髓M1/M2相比明顯降低,且差異有統(tǒng)計學(xué)意義(p0.05)。MDS-低危組與MDS-高危組骨髓M1/M2相比差異無統(tǒng)計學(xué)意義。2.3其他MDS組骨髓巨噬細胞表面CD64、CD40、CD206、CD163表達與正常對照組骨髓巨噬細胞相比差異均無統(tǒng)計學(xué)意義。3、MDS組及正常對照組M1巨噬細胞IL-1β及TNF-αmRNA表達差異3.1 MDS組及正常對照組M1巨噬細胞IL-1βmRNA表達正常對照組IL-1βmRNA表達為2.07±1.66,MDS-低危組為0.5±0.6,MDS高危組為0.98±0.72,正常對照組與MDS-低危組及MDS-高危組相比IL-1βm RNA表達均升高,且差異有統(tǒng)計學(xué)意義(p0.05),MDS-低危組與MDS-高危組相比差異無統(tǒng)計學(xué)意義。3.2 MDS組及正常對照組M1巨噬細胞TNF-αm RNA表達正常對照組TNF-αmRNA表達為1.20±0.75,MDS組TNF-αmRNA表達為0.55±0.62,正常對照組與MDS組相比IL-1βm RNA表達升高,且差異有統(tǒng)計學(xué)意義(p0.05)。結(jié)論:(1)MDS患者BM中存在異常單核細胞的蓄積,可能與疾病的進展有關(guān);(2)MDS患者與正常的對照組相比,M2巨噬細胞占單核細胞的比例明顯升高,隨著疾病的進展,MDS患者骨髓M2占單核細胞比例進一步升高;(3)MDS患者骨髓M1/M2與正常對照組相比有明顯差異,提示MDS患者存在巨噬細胞極化的異常;(4)MDS患者骨髓巨噬細胞極化的異常,可能與MDS疾病的發(fā)生與進展有關(guān),但具體機制仍待進一步研究。
[Abstract]:Objective: to detect the ratio of bone marrow macrophages to mononuclear cells, the ratio of bone marrow macrophages to type I macrophages and the expression of surface antigen of type I and type II macrophages in the healthy control group and the patients with different risk group myelodysplastic syndrome, and to stimulate type I macrophages and detect IL- in vitro. 1 beta and TNF- alpha m RNA expression, compare the difference between the normal control group and the experimental group, and explore the role of macrophage in the pathogenesis of myelodysplastic syndrome. Background: MDS is a group of myeloid cloned diseases originating from hematopoietic stem cells. The main feature of this disease is the transformation of whole blood cell and high risk to acute leukemia. The general incidence of disease is high. Aging (average age of onset at 70-75 years) makes the management of MDS more complex, accompanied by complications associated with non blood systems, and poor tolerance for some elderly patients with high intensity treatment. Besides, for patients with AML, the therapeutic effect of the standard treatment is lower than that of the initial AML patients. Some progress has been made in the treatment of MDS. The treatment methods such as amido, diazibin, arazarin, and hematopoietic stem cell transplantation have extended the patient's survival time, but the prognosis of the patients with MDS is poor, the survival time is short, and the lack of effective treatment is not fundamentally changed, and the complications such as anemia, bleeding and infection have been significantly reduced. The quality of life of the patient can lead to the death of the patient directly. The change of microenvironment and the downregulation of the immune system lead to this differentiation. In recent years, the tumor microenvironment is one of the hot spots in the pathogenesis and treatment of tumor. The tumor microenvironment is mainly composed of cells, signal molecules, extracellular matrix, cytokine and so on. In addition, the individual tumor cells do not cause disease, but by "recruiting" normal cells, secreting inhibitory cytokine through intercellular interaction, inhibiting the killing function of immune cells and forming microenvironment conducive to the growth of tumor cells, in order to promote the progression and metastasis of tumor. Macrophages are also components of the hematopoietic microenvironment, which affect the migration and settlement of hematopoietic stem cells. In MDS, abnormal mononuclear cell accumulation is found to affect cell migration. Therefore, abnormal MDS bone marrow macrophages may play a role in the pathogenesis of MDS. Macrophages can pass through the polarization of M2. The research suggests that TAMs is M2 macrophage. On the other hand, the study found that TAMs can inhibit the expression of HLA-C in NK and CTL cells, and the membrane binding molecules such as HLA-E and HLA-G can inhibit the activation of NK cells. Activated immune effector cells (such as B, T and NK cells) were highly expressed and activated to inhibit the cytotoxicity of T cells and thus inhibit the body's immunity. Materials and methods: first, we used flow cytometry (FCM) to detect 38 MDS patients (15 LR-MDS patients, 23 HR-MDS patients) and 21 normal controls (normal control). NC) the proportion of bone marrow mononuclear cells labeled with CD14 and the average fluorescence intensity of CD14 (MFI) in bone marrow, and then CD14+, CD68+ labeled macrophages, and the ratio of macrophages to mononuclear cells and bone marrow mononuclear cells in bone marrow; and CD64, CD40 labeled macrophages (M1), CD206, CD163 labeled as type II macrophages (M2). The expression of CD64, CD40, CD206 and CD163 on the surface of macrophage was different in the normal control group. Then, the m RNA of the two groups of M1 macrophages was extracted by stimulating MDS and the normal control group of M1 macrophages in vitro, and the difference between the IL-1 beta and TNF- alpha of the two groups was compared. Results: 1, the bone marrow mononuclear cells of the 1 group and the normal control group were fine. The proportion of 1.1 bone marrow mononuclear cells in the normal control group was (2.11 + 0.93)%, the ratio of bone marrow mononuclear cells in MDS- low risk group was (1.96 + 1.53)%, and the proportion of bone marrow mononuclear cells in high risk group of MDS- was (3.66 + 3.38)%. The ratio of bone marrow mononuclear cells in normal control group was not statistically significant compared with that of low risk group; the higher risk group was not significant. The ratio of bone marrow mononuclear cells decreased, the difference was statistically significant (P0.05). The ratio of high risk group was higher than that of low risk group, the difference was statistically significant (P0.05), the average fluorescence intensity of CD14 in bone marrow mononuclear cells of normal control group was 639.05 + 359.78, and the average fluorescence intensity of bone marrow mononuclear cells in MDS- low risk group was 501.43, and the average fluorescence intensity was 501.43 in MDS- low risk group. The average fluorescence intensity of CD14 in bone marrow mononuclear cells of MDS- high risk group was 458.26 + 306.72., and the average fluorescence intensity of CD14 in bone marrow mononuclear cells was not statistically significant compared with that of low risk group, and the average fluorescence intensity of CD14 in bone marrow mononuclear cells in high risk group was higher than that in bone marrow mononuclear cells (P0.05). The high risk group was lower than the low risk group. There was no significant difference in the average fluorescence intensity of CD14 compared with bone marrow mononuclear cells. The difference of bone marrow macrophages in MDS group and normal control group was 2.1 bone marrow M1, M2 macrophage accounted for mononuclear cells in normal control group, M1 macrophages accounted for (6.41 + 7.09)% of mononuclear cells. The proportion of M1 macrophages in MDS- low risk group was (8.08 + 10.) (8.08 + 10.). 31)%, the proportion of M2 macrophages in MDS- high risk group was (7.80 + 9.41)%. There was no statistically significant difference between the three groups. The proportion of M2 macrophages in the normal control group was (1.82 + 2.47)%, and the proportion of M2 macrophages in the low risk group of MDS- was (3.18 + 3.79)%, and the proportion of M2 macrophages in the high-risk group of MDS- was (the proportion of mononuclear cells). 3.93 + 3.81)%, MDS- high risk group compared with normal control group, M2 macrophage accounted for a significant increase in mononuclear cells, and the difference was statistically significant (P0.05) 2.2 bone marrow M1 macrophage /M2 macrophage ratio normal control group bone marrow M1/M2 is 3.50 + 3.22, MDS- low risk group bone marrow M1/M2 is 1.68 + 0.78, MDS- high-risk group bone marrow M1/M2 is 1.80 + 0.88, normal Group bone marrow M1/M2 was significantly lower than that of MDS- low risk group and MDS- high risk group, and the difference was statistically significant (P0.05) in.MDS- low risk group and MDS- high-risk group, there was no significant difference in bone marrow M1/M2 between the high-risk group of MDS- and.2.3 other MDS groups. There was no statistical significance.3, MDS group and normal control group M1 macrophage IL-1 beta and TNF- alpha mRNA expression difference 3.1 MDS group and normal control group M1 macrophage IL-1 beta mRNA expression of IL-1 beta mRNA expression was 2.07 + 1.66, low risk group was 0.5 + 0.6, high-risk group was 0.98 + 0.72, normal control group compared with the low risk group and high-risk group The expression of -1 beta m RNA increased, and the difference was statistically significant (P0.05). There was no statistically significant difference between the MDS- low risk group and the MDS- high risk group. The M1 macrophage TNF- alpha m RNA was 1.20 + 0.75 in the normal control group and 0.55 + 0.62 in the normal control group, and the normal control group was compared with the normal control group. The expression of NA was increased and the difference was statistically significant (P0.05). Conclusion: (1) the accumulation of abnormal mononuclear cells in BM of MDS patients may be related to the progress of the disease. (2) the proportion of M2 macrophages in mononuclear cells increased significantly compared with the normal control group, and with the progression of the disease, the proportion of bone marrow M2 in the MDS patients was further more than that of mononuclear cells. (3) the bone marrow M1/M2 of MDS patients was significantly different from that of the normal control group, suggesting that there was an abnormal polarization of macrophage in MDS patients; (4) the abnormal polarization of bone marrow macrophages in MDS patients may be related to the occurrence and progress of MDS disease, but the specific mechanism still need to be studied one step.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R551.3

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