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【摘要】 目的:研究环孢菌素A(CsA)对再生障碍病患骨髓细胞Fas表达及凋亡率的影响。
【关键词】 环孢菌素A; 再障; 骨髓细胞; Fas表达; 凋亡率
Research on the Influence of Cyclosporin A to Patients with Aplastic Anemia’s Marrow Cells Fas Expression and Apoptosis Rate/LIU Ke.//Medical Innovation of China,2014,11(16):063-065
【Abstract】 Objective: To study the influence of Cyclosporin A (CsA) to patients with aplastic anemia’s marrow cells Fas expression and apoptosis rate. Method: From February 2010 to February 2013, in our hospital a total of 48 patients were diagnosed with aplastic anemia, who were digital randomly divided into observation group (24 cases) and control group (24 cases). The control group was treated with salvia injection, the observation group on the basis of it was treated with CsA. To compare the curative effect of the two groups, and analyze the influence of CsA to patients with aplastic anemia’s marrow cells Fas expression and apoptosis rate. Result: The total effective rate of the observation group was 83.33% (20/24), which was significantly higher than that of the control group 37.50% (9/24), and difference was statistically significant (P<0.05). To compare both the two groups before and after treatment of CD34+ Fas+ cell percentage, the difference was not statistically significant. To compare the observation group’s Fas expression of bone marrow CD34- cells with the control group, the difference was not statistically significant. The observation group after treatment’s MNC apoptosis rate was (2.27±0.74)%, which was significantly lower than (6.58±2.33)% before treatment, and (2.92±1.20)% of the control group after treatment, the differences were statistically significant (P<0.05). Conclusion: The abnormal expression of Fas has some contact with the incidence of aplastic anemia. Using CsA to treat patients with aplastic anemia can significantly reduce the bone marrow MNC apoptosis rate. It has a significant effect and is worthy of recommendation.
【Key words】 Cyclosporin A; Aplastic anemia; Bone marrow cells; Fas expression; Apoptosis rate
First-author’s address: The First Affiliated Hospital of He’nan University of Science and Technology, Luoyang 471003, China
doi:10.3969/j.issn.1674-4985.2014.16.020
再生障碍性贫血是一种骨髓造血干细胞和/或造血微环境损伤性血液病。其免疫机制发生紊乱损伤,及造血干细胞和骨髓的微环境发生损害等因素均为该病主要机制[1]。因此在治疗该病时,免疫抑制疗法可作为一类主要手段。同时,近年来有报道表明,Fas/FasL系统可有效诱导凋亡,其不仅和正常造血相关,亦和造血病理及生理状态相关,此系统和再障病患免疫发病有关机制有着一定联系,有学者认为细胞凋亡的增加是再障疾病重要性病理和生理机制,但此方面报道较少[2]。鉴于此,本文通过以环孢菌素A(CsA)药物治疗再障病患,分析其对病患骨髓细胞Fas的表达和凋亡率情况影响,现报道如下。 1 资料与方法
1.1 一般资料
1.4 观察指标
2 结果
3 讨论
以及对照组治疗后的(2.92±1.20)%。与朱琳超等[12]报道一致,表明以CsA治疗方案治疗再障,可明显减少骨髓MNC凋亡。这可能是因为再障为骨髓的造血功能发生衰竭引发全血细胞数量减少,无论其初始病因怎样变化,造血干细胞的数量减少即为其基本特征。目前不但已经观察到再障患者体内T淋巴细胞亚群分布异常、肿瘤坏死因子和白介素-2等负调控因子活性增高等免疫紊乱现象,而且能够从患者骨髓内分离出攻击CD34+细胞的T淋巴细胞克隆[13]。而CsA能够降低某些因促凋亡因素而减少损伤骨髓,抑制活化T细胞有关功能,减少对Fas高表达的CD34+细胞攻击,最终对其有关造血功能有明显改善[14-15]。笔者在研究过程中,以TUNEL方法进行检测发现再障病患MNC的凋亡率整体而言处于增高趋势,在治疗之后又下降,这证实细胞凋亡于再障疾病中的影响作用。需要指出的是,由于研究样本量较少,所得结果仍需大样本进一步验证,进而寻找深入因素,为彻底对再障疾病进行治愈而努力奋斗。
综上所述,细胞Fas异常表达和再障发病情况有一定联系,以CsA治疗再障病患,可明显降低其骨髓MNC凋亡率,疗效显著,值得临床推荐。
参考文献
[1]杨雪晶,张伟华,张秀莲,等.蛋白激酶Cθ在再生障碍性贫血患者外周血单个核细胞中的表达及对Th1、Tc1细胞的作用[J].中华血液学杂志,2012,33(11):951-953.
[2]孙伟正,王金环,马智刚,等.补髓生血颗粒对慢性再生障碍性贫血患者骨髓造血细胞黏附作用影响的研究[J].中华中医药杂志,2009,20(2):89-91.
[3]张之南,沈悌.血液病诊断及疗效标准[M].第2版.北京:科学出版社,1998:33-35.
[4] Zheng B R, Shen J P, Zhuang H F, et al. Treatment of severe aplastic anemia by immunosuppressor anti-lymphocyte globulin/anti-thymus globulin as the chief medicine in combination with Chinese drugs[J]. Chin J Integer Med,2009,15(2):145.
[5] Bing H, Siyi Y, Wei Z, et al. The use of anti-human T lymphocyte porcine immunoglobulin and cyclosporine a to treat patients with acquired severe aplastic anemia[J]. Acta Haematol,2010,124(4):245.
[6]杨桂珍.环孢菌素A联合康力龙治疗慢性再生障碍性贫血35例临床观察[J].山东医药,2008,48(7):92-93.
[7]钱新华.儿童获得性再生障碍性贫血的免疫抑制机制治疗[J].实用儿科临床杂志,2006,21(3):189-192.
[8]李风,肖亚,王平贤,等.环孢菌素A代以他克莫司延缓移植肾慢性失功临床研究[J].重庆医学,2009,38(17):2139-2141.
[9]沈红石,任传路,陈海飞,等.T-bet、GATA-3与T细胞亚群在再障中的相关性研究[J].现代生物医学进展,2012,12(9):1677-1679.
[10] Xiao Y, Jiang Z J, Pang Y, et al. Efficacy and safety of mesenchymal stromal cell treatment from related donors for patients with refractory aplastic anemia[J]. Cytotherapy,2013,15(7):760-766.
[11]阿美娜阿不都,白晓丽.8例妊娠合并再障的护理体会[J].辽宁医学院学报,2011,4(4):368-369.
[12]朱琳超,刘永林,周郁鸿,等.流式细胞术检测慢性再生障碍性贫血患者T细胞活化的研究[J].浙江中医药大学学报,2012,36(7):767-769.
[13]宫立从,张茂宏,徐从高.再生障碍性贫血发病的免疫机制[J].国外医学:输血与血液学分册,1998,26(6):384.
[14]王迎雪,徐从高,冉俊丽,等.再生障碍性贫血患者骨髓自然杀伤T细胞体外活化特性研究[J].中华血液学杂志,2010,31(8):536-539.
[15] Peinemann F, Bartel C, Grouven U, et al. First-line allogeneic hematopoietic stem cell transplantation of HLA-matched sibling donors compared with first-line ciclosporin and/or antithymocyte or antilymphocyte globulin for acquired severe aplastic anemia[J].Cochrane Database Syst Rev,2013,23(7):407-408.
(收稿日期:2014-04-08) (本文编辑:王宇)
【关键词】 环孢菌素A; 再障; 骨髓细胞; Fas表达; 凋亡率
Research on the Influence of Cyclosporin A to Patients with Aplastic Anemia’s Marrow Cells Fas Expression and Apoptosis Rate/LIU Ke.//Medical Innovation of China,2014,11(16):063-065
【Abstract】 Objective: To study the influence of Cyclosporin A (CsA) to patients with aplastic anemia’s marrow cells Fas expression and apoptosis rate. Method: From February 2010 to February 2013, in our hospital a total of 48 patients were diagnosed with aplastic anemia, who were digital randomly divided into observation group (24 cases) and control group (24 cases). The control group was treated with salvia injection, the observation group on the basis of it was treated with CsA. To compare the curative effect of the two groups, and analyze the influence of CsA to patients with aplastic anemia’s marrow cells Fas expression and apoptosis rate. Result: The total effective rate of the observation group was 83.33% (20/24), which was significantly higher than that of the control group 37.50% (9/24), and difference was statistically significant (P<0.05). To compare both the two groups before and after treatment of CD34+ Fas+ cell percentage, the difference was not statistically significant. To compare the observation group’s Fas expression of bone marrow CD34- cells with the control group, the difference was not statistically significant. The observation group after treatment’s MNC apoptosis rate was (2.27±0.74)%, which was significantly lower than (6.58±2.33)% before treatment, and (2.92±1.20)% of the control group after treatment, the differences were statistically significant (P<0.05). Conclusion: The abnormal expression of Fas has some contact with the incidence of aplastic anemia. Using CsA to treat patients with aplastic anemia can significantly reduce the bone marrow MNC apoptosis rate. It has a significant effect and is worthy of recommendation.
【Key words】 Cyclosporin A; Aplastic anemia; Bone marrow cells; Fas expression; Apoptosis rate
First-author’s address: The First Affiliated Hospital of He’nan University of Science and Technology, Luoyang 471003, China
doi:10.3969/j.issn.1674-4985.2014.16.020
再生障碍性贫血是一种骨髓造血干细胞和/或造血微环境损伤性血液病。其免疫机制发生紊乱损伤,及造血干细胞和骨髓的微环境发生损害等因素均为该病主要机制[1]。因此在治疗该病时,免疫抑制疗法可作为一类主要手段。同时,近年来有报道表明,Fas/FasL系统可有效诱导凋亡,其不仅和正常造血相关,亦和造血病理及生理状态相关,此系统和再障病患免疫发病有关机制有着一定联系,有学者认为细胞凋亡的增加是再障疾病重要性病理和生理机制,但此方面报道较少[2]。鉴于此,本文通过以环孢菌素A(CsA)药物治疗再障病患,分析其对病患骨髓细胞Fas的表达和凋亡率情况影响,现报道如下。 1 资料与方法
1.1 一般资料
1.4 观察指标
2 结果
3 讨论
以及对照组治疗后的(2.92±1.20)%。与朱琳超等[12]报道一致,表明以CsA治疗方案治疗再障,可明显减少骨髓MNC凋亡。这可能是因为再障为骨髓的造血功能发生衰竭引发全血细胞数量减少,无论其初始病因怎样变化,造血干细胞的数量减少即为其基本特征。目前不但已经观察到再障患者体内T淋巴细胞亚群分布异常、肿瘤坏死因子和白介素-2等负调控因子活性增高等免疫紊乱现象,而且能够从患者骨髓内分离出攻击CD34+细胞的T淋巴细胞克隆[13]。而CsA能够降低某些因促凋亡因素而减少损伤骨髓,抑制活化T细胞有关功能,减少对Fas高表达的CD34+细胞攻击,最终对其有关造血功能有明显改善[14-15]。笔者在研究过程中,以TUNEL方法进行检测发现再障病患MNC的凋亡率整体而言处于增高趋势,在治疗之后又下降,这证实细胞凋亡于再障疾病中的影响作用。需要指出的是,由于研究样本量较少,所得结果仍需大样本进一步验证,进而寻找深入因素,为彻底对再障疾病进行治愈而努力奋斗。
综上所述,细胞Fas异常表达和再障发病情况有一定联系,以CsA治疗再障病患,可明显降低其骨髓MNC凋亡率,疗效显著,值得临床推荐。
参考文献
[1]杨雪晶,张伟华,张秀莲,等.蛋白激酶Cθ在再生障碍性贫血患者外周血单个核细胞中的表达及对Th1、Tc1细胞的作用[J].中华血液学杂志,2012,33(11):951-953.
[2]孙伟正,王金环,马智刚,等.补髓生血颗粒对慢性再生障碍性贫血患者骨髓造血细胞黏附作用影响的研究[J].中华中医药杂志,2009,20(2):89-91.
[3]张之南,沈悌.血液病诊断及疗效标准[M].第2版.北京:科学出版社,1998:33-35.
[4] Zheng B R, Shen J P, Zhuang H F, et al. Treatment of severe aplastic anemia by immunosuppressor anti-lymphocyte globulin/anti-thymus globulin as the chief medicine in combination with Chinese drugs[J]. Chin J Integer Med,2009,15(2):145.
[5] Bing H, Siyi Y, Wei Z, et al. The use of anti-human T lymphocyte porcine immunoglobulin and cyclosporine a to treat patients with acquired severe aplastic anemia[J]. Acta Haematol,2010,124(4):245.
[6]杨桂珍.环孢菌素A联合康力龙治疗慢性再生障碍性贫血35例临床观察[J].山东医药,2008,48(7):92-93.
[7]钱新华.儿童获得性再生障碍性贫血的免疫抑制机制治疗[J].实用儿科临床杂志,2006,21(3):189-192.
[8]李风,肖亚,王平贤,等.环孢菌素A代以他克莫司延缓移植肾慢性失功临床研究[J].重庆医学,2009,38(17):2139-2141.
[9]沈红石,任传路,陈海飞,等.T-bet、GATA-3与T细胞亚群在再障中的相关性研究[J].现代生物医学进展,2012,12(9):1677-1679.
[10] Xiao Y, Jiang Z J, Pang Y, et al. Efficacy and safety of mesenchymal stromal cell treatment from related donors for patients with refractory aplastic anemia[J]. Cytotherapy,2013,15(7):760-766.
[11]阿美娜阿不都,白晓丽.8例妊娠合并再障的护理体会[J].辽宁医学院学报,2011,4(4):368-369.
[12]朱琳超,刘永林,周郁鸿,等.流式细胞术检测慢性再生障碍性贫血患者T细胞活化的研究[J].浙江中医药大学学报,2012,36(7):767-769.
[13]宫立从,张茂宏,徐从高.再生障碍性贫血发病的免疫机制[J].国外医学:输血与血液学分册,1998,26(6):384.
[14]王迎雪,徐从高,冉俊丽,等.再生障碍性贫血患者骨髓自然杀伤T细胞体外活化特性研究[J].中华血液学杂志,2010,31(8):536-539.
[15] Peinemann F, Bartel C, Grouven U, et al. First-line allogeneic hematopoietic stem cell transplantation of HLA-matched sibling donors compared with first-line ciclosporin and/or antithymocyte or antilymphocyte globulin for acquired severe aplastic anemia[J].Cochrane Database Syst Rev,2013,23(7):407-408.
(收稿日期:2014-04-08) (本文编辑:王宇)