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目的探讨免疫相关性血细胞减少(immuno-related hematocytopenia,IRH)患者骨髓“造血细胞岛”(hematopoietic islands,HI)对病变造血细胞破坏的免疫机制。方法 ELISA法检测患者血清IL-12和IL-17水平,观察其体内炎性因子的含量,免疫荧光(immunofluorescence,IF)染色,观察其骨髓HI中免疫细胞Fcγ受体Ⅱ(Fcγrecepter Ⅱ,FcγRⅡ)、甘露糖受体(mannose receptor,MR)、IL-12、IL-17A、IL-17RA和ICAM-1表达,分析HI的相关病理作用。结果 37例患者血清IL-12和IL-17的水平分别为(318.59±20.13)ng/L和(45.81±8.27)ng/L,显著高于对照组[(94.05±3.26)ng/L和(20.03±1.14)ng/L];经治疗后均下降近正常,较治疗前差异显著,P<0.01。患者骨髓中HI主要为抗体依赖性细胞毒(antibody dependent cell cytotoxicity,ADCC)型、巨噬细胞型(Mφ)和抗原提呈(antigen presenting,AP)型3种,HI中的免疫细胞高表达FcγRⅡ、MR,呈分泌状表达IL-12、IL-17A、IL-17RA和ICAM-1,在上述免疫分子的介导下,发挥体液免疫和细胞免疫及炎性损伤作用,破坏病变的造血细胞。结论 IRH患者骨髓中不同造血细胞岛是活化的免疫细胞破坏病变血细胞的不同免疫形式,是造血细胞在骨髓中“原位破坏的”重要场所。
Objective To investigate the immune mechanism of hematopoietic islands (HI) on the hematopoietic cell destruction in patients with immuno-related hematocytopenia (IRH). Methods Serum levels of IL-12 and IL-17 were measured by ELISA. The levels of inflammatory cytokines, immunofluorescence (IF) staining and the expression of Fcγ receptor II (FcγRⅡ) , Mannose receptor (MR), IL-12, IL-17A, IL-17RA and ICAM-1 expression, the relevant pathological effects of HI were analyzed. Results The serum levels of IL-12 and IL-17 in the 37 patients were (318.59 ± 20.13) ng / L and (45.81 ± 8.27) ng / L, respectively, significantly higher than those in the control group [(94.05 ± 3.26) 20.03 ± 1.14) ng / L]. After treatment, they both decreased and approached normal, with significant difference (P <0.01). In the bone marrow of patients, HI mainly expressed antibody dependent cell cytotoxicity (ADCC), macrophage type (Mφ) and antigen presenting (AP) type. The immune cells in HI highly expressed FcγRⅡ , MR expressed secretory IL-12, IL-17A, IL-17RA and ICAM-1, under the guidance of the above immune molecules, play a role in humoral and cellular immunity and inflammatory damage, destruction of diseased hematopoietic cells. Conclusion Different hematopoietic island in the bone marrow of IRH patients are different immune forms that the activated immune cells destroy diseased blood cells and are important places where the hematopoietic cells are “destroyed in situ” in the bone marrow.