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本研究旨在应用骨髓间接Coombs试验方法,并探讨其对免疫相关性全血细胞减少症(IRP)患者的临床诊断意义。实验组选取30例全血细胞减少患者〔IRP 22例,意义未明血细胞减少患者(ICUS)8例〕骨髓上清液和15名缺铁性贫血对照者骨髓有核细胞孵育,对照组选取15名缺铁性贫血患者自身骨髓有核细胞与骨髓上清液孵育。应用流式细胞术(FCM)检测孵育45 min后骨髓造血细胞(CD15+、GlyCoA+和CD34+细胞)膜抗体阳性率,并与其临床指标进行相关性分析。结果显示:30例患者中(骨髓直接Coombs试验16例阳性,14例阴性),骨髓间接Coombs试验阳性者共16例,阳性率53.33%;其中8例ICUS患者中4例骨髓膜抗体出现阳性,阳性率50%。实验组CD15+IgM中位阳性率为0.34%,明显高于对照组0.20%(P<0.05);CD34+IgG、IgM中位阳性率分别为0.64%,0.21%,明显高于对照组0.00%(P<0.05)、0.00%(P<0.05);GlyCoA+IgG、IgM阳性率分别为(0.83±0.75)%,(2.12±1.98)%,明显高于对照组(0.47±0.43)%(P<0.05)、(0.68±0.64)%(P<0.01)。CD15+IgG、IgM阳性率分别与CD5+B细胞比例呈显著正相关,与其他临床指标均无相关性;GlyCoA+IgG、IgM阳性率分别与患者入院时血红蛋白水平、网织红细胞百分率、骨髓红系比例及树突细胞亚群比例(DC1/DC2)呈明显负相关,与CD5+B细胞比例和间接胆红素水平呈显著正相关。结论:部分IRP及ICUS患者骨髓上清液中存在针对骨髓造血细胞的抗体(IgG或IgM),且阳性率的高低与疾病的进展呈一定相关性;部分抗体可作用于正常骨髓有核细胞膜蛋白成分。
This study aimed to apply the indirect bone marrow Coombs test and explore its clinical significance in immune-associated pancytopenia (IRP). In the experimental group, 30 cases of pancytopenia [22 cases of IRP, 8 cases of unidentified cytopenias (ICUS)] were selected and bone marrow nucleated cells were incubated with 15 cases of iron deficiency anemia in control group Patients with iron-deficiency anemia own bone marrow cells and bone marrow supernatant incubated. The positive rates of membrane antibody of bone marrow hematopoietic cells (CD15 +, GlyCoA + and CD34 + cells) after 45 min incubation were detected by flow cytometry (FCM), and their correlation with clinical parameters was analyzed. The results showed that among the 30 patients (16 in the bone marrow direct Coombs test and 14 in the negative), there were 16 positive cases of Bone marrow indirect Coombs test, the positive rate was 53.33%. In 4 of 8 ICUS patients, the bone marrow antibodies were positive, Positive rate of 50%. The positive rate of CD15 + IgM in experimental group was 0.34%, which was significantly higher than that of control group (P <0.05). The positive rates of CD34 + IgG and IgM were 0.64% and 0.21% respectively, which were significantly higher than 0.00% (0.83 ± 0.75)% and (2.12 ± 1.98)% respectively, which was significantly higher than that of the control group (P <0.05) and 0.00% (P <0.05) <0.05), (0.68 ± 0.64)% (P <0.01). The positive rates of CD15 + IgG and IgM were positively correlated with the proportion of CD5 + B cells, but not with other clinical indexes. The positive rates of GlyCoA + IgG and IgM were correlated with the levels of hemoglobin, reticulocyte, There was a significant negative correlation between the proportion of DC1 / DC2 and the ratio of dendritic cell subsets and the ratio of CD5 + B cells and indirect bilirubin. CONCLUSIONS: Antibody (IgG or IgM) against myeloid hematopoietic cells is present in some bone marrow supernatant of IRP and ICUS patients. The positive rate of IgA is correlated with the progression of the disease. Some antibodies may act on the membrane proteins of normal bone marrow nucleated cells ingredient.