【摘要】 目的:探讨再生障碍性贫血(AA)患者免疫T细胞亚群、TNF-α、IFN-γ和s Fas表达水平与其病情严重程度及预后的相关性。方法:选择本院收治的95例再生碍性贫血患者纳入AA组,同时根据患者病情分为急性组43例、慢性组52例,再选择同期来本院健康志愿者50例作为对照组。检测比较各组受试者免疫T细胞亚群变化及血清TNF-α、IFN-γ和s Fas水平,并采用ROC曲线法分析各指标对患者病情严重程度的评估价值。另外,对95例再生障碍性贫血患者进行随访,采用Kaplan-Miere生存曲线法分析不同指标水平对患者无进展生存期的影响。结果:AA组患者CD4~+水平、CD4~+/CD8~+比值显著低于对照组(P <0. 05),CD8~+水平显著高于对照组(P <0. 05);急性组患者CD4~+水平、CD4~+/CD8~+比值显著低于慢性组(P <0. 05),CD8~+水平显著高于慢性组(P <0. 05)。AA组患者血清TNF-α、IFN-γ水平显著高于对照组(P <0. 05),s Fas水平显著低于对照组(P <0. 05);急性组患者血清TNF-α、IFN-γ水平显著高于慢性组(P <0. 05),s Fas水平显著低于慢性组(P <0. 05)。采用ROC曲线法分析再生障碍性贫血患者各指标对病情严重程度的预测价值显示,CD4~+/CD8~+比值、TNF-α、IFN-γ及s Fas水平对患者病情预测曲线下面积分别为0. 954、0. 763、0. 853、0. 857。Kaplan-Miere生存曲线法分析各指标对患者预后的影响表明,CD4~+/CD8~+比值对患者无进展生存期有明显影响(P <0. 05),TNF-α、IFN-γ及s Fas水平对患者无进展生存期无明显影响(P> 0. 05)。结论:再生障碍性贫血患者存在有明显的T细胞亚群异常,且血清TNF-α、IFN-γ以及s Fas水平与再生障碍性贫血之间存在一定相关性,各指标可反映患者疾病严重程度,且T细胞亚群改变对患者临床预后具有重要影响。更多还原

【Abstract】 Objective: To explore the correlation of immune T cell subsets and expression levels of TNF-α,IFN-γand sFas with the severity and prognosis of aplastic anemia(AA) patients. Methods: Ninety-five patients with aplastic anemia treated in our hospital were selected and enrolled in A A group,43 cases of which were included in the acute group and 52 cases in the chronic group according to the disease status of patients. Then, 50 cases of healthy volunteers in the same period were enrolled in the control group, and the changes of immune T cell subsets, and sFas serum TNF-α,IFN-γ and levels of the 3 groups were compared. The ROC curve was used to analyze the value of each index for evaluating the severity of the disease, 95 patients with aplastic anemia were followed up and the Kaplan-Miere survival curve was used to analyze the effect of different index levels on the progression-free survival of the patients. Results : the serum level of CD4~+ level and CD~4 +/CD8~+ ratio in A A group were significantly lower than those in the control group(P <0. 05), and the CD8~+ level in AA group was significantly higher than that in the control group(P <0. 05). The CD4~+ level and CD4~+/CD8~+ ratio in the acute group was significantly lower than those in the chronic group(P <0.05),and the CD8~+ level in the acute group was significantly higher than that in the chronic group(P < 0. 05). The serum level of TNF-α and IFN-γ of the patients in AA group was significantly higher than those in the control group(P< 0. 05), and the level of sFas in AA group was significantly lower than those in the control group(P <0. 05). The levels of serum TNF-α and IFN-γ in the acute group were significantly higher than that in the chronic group(P <0.05),and the level of sFas was significantly lower than that in the chronic group(P <0. 05). The analysis of each index value for predicting the severity of AA by ROC showed that the area under curve of CD4~+/CD8~+, TNF-α IFN-γ and sFas for predicting the patients ’condition was 0. 954, 0. 763, 0. 853 and 0. 857, respectively. Kaplan-Miere survival curve analysis showed that CD4~+/CD8~+ ratio had a significant effect on progression-free survival(P <0. 05), the TNF-α,IFN-γ and sFas levels had no significant effect on progression-free survival(P >0.05). Conclusion; The patients with aplastic anemia have significantly abnormal T lymphocyte subsets, there is a certain correlation between the serum TNF-α,IFN-γ and sFas levels with aplastic anemia, each index can reflect the disease severity, and the changes of T lymphocyte subsets has important influence on the clinical prognosis of the patients.更多还原