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目的研究重症肌无力(MG)患者外周血多群调节性 T 细胞的水平及其 B 细胞表达 B细胞激活因子受体(B cell-activating factor receptor,BAFF-R)的情况。方法应用四色流式细胞仪检测61例 MG 患者与23名健康对照外周血调节性 T 细胞(CD_4~+ CD_(25)~(high)Foxp3~+、CD_8~+CD_(28)~-、CD_8~+CD_(122)~+)以及 CD_(19)~+BAFF-R~+细胞的百分率。结果 MG 组与健康对照组外周血 CD_4~+CD_(25)~(high)Foxp3~+T 细胞的百分率分别为32.12%±16.12%与65.15%±14.72%,MG 组该群调节性 T 细胞的水平明显低于健康对照组(P<0.01);两组 CD_8~+CD_(28)~-及 CD_8~+CD_(122)~+T 细胞的水平差异无统计学意义。此外,MG 组外周血CD_(19)~+BAFF-R~+细胞的水平(10.57%±5.59%)显著高于健康对照组(5.38%±3.87%,P<0.01)。大剂量激素或大剂量激素加丙种球蛋白治疗后短期内可使 MG 组外周血 CD_4~+CD_(25)~(high)Foxp3~+调节性 T 细胞的百分率增加(P<0.05)。结论 MG 患者 Foxp3~+的 CD_4~+CD_(25)~(high)调节性 T 细胞的减少提示 MG 患者存在免疫和耐受的失衡,显示了 T 细胞的自身免疫性。在 B 细胞方面,MG 患者外周血 CD_(19)~+B 细胞上 BAFF-R 表达增高,提示其体内 B 细胞已处于易激活状态。
Objective To investigate the levels of peripheral blood mononuclear cells and their expression of B cell-activating factor receptor (BAFF-R) in patients with myasthenia gravis (MG). Methods Twenty-four patients with MG and 23 healthy controls were enrolled in this study. Tregs of CD25 + CD25 + high Foxp3 +, CD8 + CD28 + CD_8 ~ + CD_ (122) ~ +) and the percentage of CD_ (19) ~ + BAFF-R ~ + cells. Results The percentage of CD_4 ~ + CD_ (25) ~ (high) Foxp3 ~ + T cells in peripheral blood of MG group and healthy control group were 32.12% ± 16.12% and 65.15% ± 14.72%, respectively. In MG group, the percentage of regulatory T cells (P <0.01). There was no significant difference in the levels of CD_8 ~ + CD_ (28) ~ - and CD_8 ~ + CD_ (122) ~ + T cells between the two groups. In addition, the levels of CD19 + BAFF-R ~ + cells in peripheral blood of MG group were significantly higher than that of healthy control group (10.57% ± 5.59% vs 5.38% ± 3.87%, P <0.01). The percentage of CD_4 ~ + CD_ (25) ~ (high) Foxp3 ~ + regulatory T cells in peripheral blood of MG group increased significantly (P <0.05) after treatment with high-dose hormone or high-dose hormone plus gamma globulin. Conclusion The decrease of Foxp3 ~ + CD_4 ~ + CD25 (high) regulatory T cells in patients with MG suggests imbalance of immunity and tolerance in patients with MG, indicating the autoimmunity of T cells. In B cells, the expression of BAFF-R on CD 19 (19) ~ + B cells in MG patients is increased, suggesting that B cells in vivo are in an activated state.