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目的检测免疫相关性全血细胞减少症(IRP)患者骨髓B淋巴细胞的数量、功能及凋亡相关蛋白水平,以探讨B淋巴细胞在IRP发病中的作用。方法采用流式细胞术测定25例初诊患者,15例治疗后血象恢复正常的患者和10例正常人骨髓总B淋巴细胞、CD5~+B淋巴细胞细胞的数量,B淋巴细胞胞浆内免疫球蛋白IgM的表达以及B淋巴细胞膜表面凋亡相关蛋白Fas抗原(CD95)、胞浆内抗凋亡蛋白bcl—2的表达。结果 IRP初诊患者总B淋巴细胞、CD5~+B淋巴细胞比例显著高于治疗后血象恢复组和正常人(P均<0.05),后两组相比无显著性差异(P>0.05);初诊患者骨髓B淋巴细胞免疫球蛋白IgM的表达也明显高于其他两组。三组患者B淋巴细胞Fas抗原的表达率无明显区别(P均>0.05);初诊患者B淋巴细胞胞浆内bcl—2的表达率显著高于其它两组(P均<0.05),治疗后血象恢复组也显著高于正常对照组(P<0.01);各组间B淋巴细胞凋亡相关指数(CD19~+CD95~+/CD19~+Bcl-2~+)比较,初诊组显著低于治疗后血象恢复组和对照组(P均<0.01),治疗后血象恢复组也显著低于对照组(P<0.05);B淋巴细胞的比例与治疗起效时间呈正相关(r=0.69,P<0.01)。结论 IRP患者自身抗体的产生可能与B淋巴细胞及其亚群数量异常、功能亢进及凋亡受抑有关。
Objective To investigate the quantity and function of bone marrow B lymphocytes in patients with immune-associated pancytopenia (IRP) and the level of apoptosis-related proteins in order to explore the role of B lymphocytes in the pathogenesis of IRP. Methods Flow cytometry was used to determine the number of 25 cases of newly diagnosed patients, 15 cases of normal blood returned to normal after treatment and 10 cases of normal bone marrow total B lymphocytes, CD5 ~ + B lymphocyte number, B lymphocyte cytoplasmic immunoglobulin The expression of protein IgM and the expression of Fas antigen (CD95) on the surface of B lymphocytes, and the expression of bcl-2, an intracellular anti-apoptotic protein. Results The proportion of total B lymphocytes and CD5 ~ + B lymphocytes in newly diagnosed IRP patients was significantly higher than that in patients with post-treatment blood resuscitation and normal controls (P <0.05). There was no significant difference between the two groups (P> 0.05) Patients with bone marrow B lymphocyte immunoglobulin IgM expression was significantly higher than the other two groups. There was no significant difference in the expression of Fas antigen in B lymphocytes between the three groups (all P> 0.05). The expression of bcl-2 in the cytoplasm of B lymphocytes in newly diagnosed patients was significantly higher than that in the other two groups (all P <0.05) The level of B lymphocyte apoptosis index (CD19 ~ + CD95 ~ + / CD19 ~ + Bcl-2 ~ +) in each group was significantly lower than that of the normal control group (P <0.01) After treatment, the blood recovery group and the control group (P <0.01), after treatment, the blood recovery group was significantly lower than the control group (P <0.05); the proportion of B lymphocytes was positively correlated with the onset of treatment (r = 0.69, P <0.01). Conclusions The production of autoantibodies in patients with IRP may be related to abnormal numbers of B lymphocytes and their subpopulations, hyperfunction and inhibition of apoptosis.