【摘要】 目的观察HAG联合地西他滨对骨髓增生异常综合征（MDS）患者免疫功能的影响。方法将2014年2月至2015年1月收治的MDS患者86例纳入研究范围,随机分为HAG组和联合组,每组43例。HAG组给予高三尖杉酯碱+阿糖胞苷+粒细胞集落刺激因子治疗。联合组在HAG组治疗基础上加用地西他滨治疗。比较2组淋巴细胞亚群表型(CD⁺₃ T细胞、CD⁺₁₉ B细胞、CD3-CD⁺₅₆ NK细胞)、T淋巴细胞亚群（CD⁺₄ T细胞、CD⁺₈ T细胞、CD⁺₄/CD⁺₈）、调节性T细胞（Treg）、辅助性T细胞（Th17）、Treg/Th17及相关转录因子（Foxp3、RORγt）、细胞因子[γ干扰素（IFN-γ）、肿瘤坏死因子α（TNF-α）]变化。结果 2组治疗前CD⁺₃ T细胞、CD⁺₁₉ B细胞、CD3-CD⁺₅₆ NK细胞、CD⁺₄ T细胞、CD⁺₈ T细胞、CD⁺₄/CD⁺₈、Treg细胞、Th17细胞、Treg/Th17、Foxp3、RORγt mRNA表达、IFN-γ、TNF-α比较差异无统计学意义（P>0.05）;2组治疗后CD⁺₃ T细胞、CD⁺₁₉ B细胞、CD3-CD⁺₅₆ NK细胞、CD⁺₄ T细胞、CD⁺₄/CD⁺₈、Th17细胞、RORγt mRNA表达均较治疗前显著升高（P<0.05）,CD⁺₈ T细胞、Treg细胞、Treg/Th17、Foxp3 mRNA表达、IFN-γ、TNF-α均较治疗前显著降低（P<0.05）,且联合组以上指标变化程度较HAG组更明显（P<0.05）。结论 HAG联合地西他滨能够改善MDS患者免疫功能,机制与调控Treg/Th17和T淋巴细胞亚群水平有关。更多还原

【Abstract】 Objective To investigate the effects of HAG combined with decitabine on immune function in patients with myelodysplastic syndrome（MDS）.Methods A total of 86 patients with MDS who were treated in our hospital from February 2014 to January 2015 were enrolled in the study, who were randomly divided into HAG group（n=43） and combination treatment group（n=43）. The patients in HAG group were treated by homoharringtonine + cytarabine + granulocyte colony stimulating factor, however, the patients in combination treatment group, on the basis of that, were treated by decitabine. The changes of lymphocytes subsets（CD⁺₃ T, CD+19 B and CD3 CD+56 NK）, T lymphocytes subsets（CD⁺₄T,CD⁺₈T and CD⁺₄/CD⁺₈）, regulatory T cells（Treg）, helper T cell（Th17）, Treg/Th17, and the related transcription factors（Foxp3 and RORγt）, cytokines（IFN-γ and TNF-α） were observed and compared between the two groups.Results Before treatment, there were no significant differences in the levels of CD⁺₃T, CD+19 B, CD3 CD+56 NK, CD⁺₄T, CD⁺₈T,CD⁺₄/CD⁺₈, Treg, Th17, Treg/Th17, the mRNA expression levels of Foxp3 and RORγt, IFN-γ and TNF-α between the two groups（P>0.05）. After the treatment, the levels of CD⁺₃T, CD+19 B, CD3 CD+56 NK, CD⁺₄T,CD⁺₄/CD⁺₈, Th17, the mRNA expression levels of RORγt in both groups were significantly increased（P<0.05）, however the levels of CD⁺₈T, Treg, Treg/Th17, the mRNA expression levels of Foxp3, IFN-γ and TNF-α were significantly decreased（P<0.05）. Moreover the changes in the above indexes in combination treatment group were more significant than those in HAG group（P<0.05）.Conclusion HAG combined with decitabine can improve the immune function of patients with MDS,and its action mechanism is related with regulating the levels of Treg/Th17 cells and T lymphocytes subsets.更多还原