本文選題：多發(fā)性骨髓瘤　切入點(diǎn)：樹突狀細(xì)胞　出處：《蘭州大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討初治多發(fā)性骨髓瘤(multiple myeloma,MM)患者經(jīng)硼替佐米聯(lián)合化療前后外周血髓樣樹突狀細(xì)胞(myeloid dendritic cells,mDC)和漿細(xì)胞樣樹突狀細(xì)胞(plasmacytoid dendritic cells,pDC)的比例,細(xì)胞因子白介素6(interleukin-6,IL-6)、腫瘤壞死因子-α(tumor necrosis factor-alpha,TNF-α)水平的變化及與臨床預(yù)后指標(biāo)β2-微球蛋白(β2-microglobulin,β2-MG)的相關(guān)性。方法:收集2013年12月~2015年12月在蘭州大學(xué)第二醫(yī)院血液科住院部確診的初治多發(fā)性骨髓瘤患者21例,正常對照組11例,患者均使用PAD方案治療1~2個(gè)療程,應(yīng)用流式細(xì)胞術(shù)檢測正常對照組、初治MM患者及治療后mDC與pDC比例,應(yīng)用酶聯(lián)免疫吸附試驗(yàn)(enzyme linked immunosorbent assay,ELISA)檢測外周血IL-6、TNF-α水平,分析mDC、pDC比例及IL-6、TNF-α水平與β2-MG之間的相關(guān)性。結(jié)果:1.MM組治療前與正常對照組相比,mDC比例降低(0.57±0.12%vs1.06±0.10%,P0.001),pDC比例降低(0.17±0.11%vs 0.79±0.10%,P0.001);MM組治療后與治療前相比,mDC比例增高(0.98±0.15%vs 0.57±0.12%,P0.001),pDC比例增高(0.69±0.30%vs 0.17±0.11%,P0.001);MM組治療后與正常對照組相比,mDC比例為(0.98±0.15%vs 1.06±0.10%,P=0.050),pDC比例為(0.69±0.30%vs 0.79±0.10%,P=0.138),差異無統(tǒng)計(jì)學(xué)意義。比較mDC、pDC比例在不同分期之間的差異,只有Ⅰ期與Ⅲ期之間存在統(tǒng)計(jì)學(xué)差異:mDC(0.67±0.12%vs 0.52±0.10%,P0.05),pDC(0.28±0.16%vs 0.11±0.04%,P0.05)。2.MM組在治療前,外周血mDC比例與血清β2-MG水平呈負(fù)相關(guān)(r=㧟0.569,P0.05),pDC比例與血清β2-MG水平呈負(fù)相關(guān)(r=㧟0.693,P0.05)。不同分期中,只有Ⅲ期患者外周血mDC比例與血清β2-MG水平呈負(fù)相關(guān)(r=㧟0.883,P0.05),pDC比例與血清β2-MG水平呈負(fù)相關(guān)(r=㧟0.881,P0.05)。3.MM組治療前與正常對照組相比,IL-6水平顯著增高(13.78±7.08 vs 4.73±2.19,P0.001),TNF-α水平顯著增高(34.05±10.11 vs 14.98±7.57,P0.001),差異有統(tǒng)計(jì)學(xué)意義。MM組治療后與治療前相比,IL-6水平顯著降低(6.42±3.33 vs13.78±7.08,P0.001),TNF-α水平顯著降低(18.72±5.43 vs 34.05±10.11,P0.001),差異有統(tǒng)計(jì)學(xué)意義。MM組治療后與正常對照組相比,IL-6水平為(6.42±3.33 vs 4.73±2.19,P=0.059),TNF-α水平為(18.72±5.43 vs 14.98±7.57,P=0.090),差異無統(tǒng)計(jì)學(xué)意義。不同分期IL-6、TNF-α的水平也存在統(tǒng)計(jì)學(xué)差異,Ⅰ期與Ⅱ期相比,IL-6水平顯著降低(7.20±3.84 vs 11.78±2.80,P0.05),TNF-α水平顯著降低(24.18±5.78 vs 32.92±5.86,P0.05);Ⅰ期與Ⅲ期相比,IL-6水平顯著降低(7.20±3.84 vs 19.69±5.97,P0.001),TNF-α水平顯著降低(24.18±5.78 vs 41.39±8.87,P0.001);Ⅱ期與Ⅲ期相比,IL-6水平顯著降低(11.78±2.80 vs 19.69±5.97,P0.05),TNF-α水平顯著降低(32.92±5.86 vs41.39±8.87,P0.05),三組之間均有統(tǒng)計(jì)學(xué)差異。4.MM組治療前IL-6水平與血清β2-MG水平呈正相關(guān)(r=0.623,P0.01),TNF-α水平與血清β2-MG呈正相關(guān)(r=0.769,P0.01),IL-6水平與TNF-α水平呈正相關(guān)(r=0.515,P0.05)。不同分期中,只有Ⅲ期患者外周血IL-6水平與血清β2-MG水平呈正相關(guān)(r=0.800,P0.05),TNF-α水平與血清β2-MG水平呈正相關(guān)(r=0.833,P0.05)。結(jié)論:1.初治MM患者治療前外周血mDC、pDC比例降低,與β2-MG水平呈負(fù)相關(guān),初始及繼發(fā)免疫缺陷可能均參與MM發(fā)病;2.初治MM患者治療前IL-6、TNF-α水平增高,與β2-MG水平呈正相關(guān),提示細(xì)胞因子IL-6、TNF-α參與MM發(fā)病;3.MM患者分期增加,DC亞群比例降低,細(xì)胞因子IL-6、TNF-α水平增高,預(yù)后越差;4.硼替佐米治療可增加DC亞群比例,降低細(xì)胞因子IL-6、TNF-α的水平,在一定程度上改善了MM患者免疫紊亂。
[Abstract]:Objective: To investigate the effect of multiple myeloma (multiple myeloma, MM) were treated by bortezomib and bortezomib in combination with chemotherapy on peripheral blood dendritic cells (myeloid dendritic cells, mDC) and plasmacytoid dendritic cells (plasmacytoid dendritic cells, pDC) the ratio of cytokine interleukin 6 (interleukin-6, IL-6), tumor necrosis factor alpha (tumor alpha necrosis factor-alpha, TNF-) level changes and clinical and prognostic indicators of beta 2- microglobulin (beta 2-microglobulin and beta 2-MG) correlation. Methods: from December 2013 ~2015 year in December 21 cases of myeloma patients hospitalized in the Department of Hematology of Second Hospital Affiliated to Lanzhou University of the Ministry confirmed early multiple, 11 in normal control group cases of patients using the PAD regimen in the treatment of 1~2 treatment, the application of flow cytometry in the normal control group, the ratio of mDC and pDC of MM patients with initial treatment and after treatment, using enzyme linked immunosorbent assay (enzyme linked IMM unosorbent assay,ELISA)媯，

本文編號(hào)：1584415