多发性骨髓瘤患者外周血CD4~+CD25~+和CD8~+CD28~-调节性T细胞研究

目的:探讨CD4~+CD25~+和CD8~+CD28~-调节性T细胞(Tregs)在多发性骨髓瘤(MM)患者外周血中的变化及意义.方法:采用流式细胞术检测38例MM患者及20例健康对照外周血CD4~+CD25~+和CD8~+CD28~-Tregs水平.分别采用溴甲酚绿法、透射免疫比浊法测定患者血清白蛋白(Alb)、β2-微球蛋白(β2-MG).结果:初诊MM患者外周血CD4~+CD25~(+/high)、CD4~+CD25~(high)CD127~(low)及CD8~+CD28~-Tregs比率均明显升高;CD4~+CD25~(+/high)和CD4~+CD25~)(high)CD127~(low)Tregs比率在各临床分期均较对照组升高,随分期增高呈现增加趋势,且CD4~+CD25~(high)和CD4~+CD25~(high)CD127~(low)Tregs在Ⅲ期患者显著高于Ⅰ期患者;CD8~+CD28~(-Tregs)在Ⅱ、Ⅲ期显著高于正常对照,且Ⅱ期高于Ⅰ期,Ⅲ期高于Ⅱ期,逐期递增,而在Ⅰ期与对照组比较无显著差异;CD4~+CD25~(+/high)和CD4~+CD25~(high)CD127~(low)Tregs比率在进展期和稳定期均较对照组升高,但两期之间比较无明显差异,而CD8~+CD28~-Tregs在进展期高于稳定期及对照组,稳定期和对照组间比较无明显差异;CD4~+CD25~(high)Tregs和CD4~+CD25~(high)CD127~(low)Tregs比率与Alb水平均呈负相关.结论:MM患者体内存在CD4~+CD25~+Tregs和CD8~+ CD28~-Tregs异常增加,可能是MM免疫逃逸的一个重要机制,这些变化同临床分期、病情进展及预后存在一定程度相关性.

Circulating CD4~+CD25~+ and CD8~+CD28~- T regulate cells in multiple myeloma

Objective: The study was designed to evaluate the changes and significance of circulating CD4~+CD25~+ and CD8~+CD28~- regulatory T cells (Tregs) in patients with multiple myeloma (MM).Methods:CD4~+CD25~+ and CD8~+CD28~-Tregs in peripheral blood of 38 patients with MM and of 20 healthy doners were measured by flow cytometry.Serum albumin and β_2-MG in patients with MM were measured using bromocresol green method,transmission turbidimetry respectively.Results:Compared to those of the controls,the proportions of CD4~+CD25~(+/high),CD4~+CD25~(high) CD127~(low) and CD8~+CD28~-Treg cells in newly diagnosed MM patients were elevated.Furthermore,the proportions of CD4~+CD25~(high) and CD4~+CD25~(high)CD127~(low) Tregs in each clinical stage were elevated when compared to those of the controls.The number of the Tregs were increasing with clinical stages and were significantly higher in stage Ⅲ MM than in stageⅠ MM;In stageⅡand Ⅲ MM,there were also elevated proportions of CD8~+CD28~- Tregs,increasing with clinical stages.However,there were no differences when compared between stage Ⅰ MM and the controls;Both the proportions of CD4~+CD25~(+/high) and CD4~+CD25~(high)CD127~(low) Tregs in active MM were not different from stable MM,although all of them were higher than those of controls.The proportion of CD8~+CD28~- Tregs was higher in active MM than in stable MM and controls,but there were no differences when compared between active and stable MM.The proportions of both CD4~+CD25~(high) Tregs and CD4~+CD25~(high)CD127~(low)Tregs had negative correlation with the levels of serum albumin.Conclusion:MM patients have elevated levels of circulating CD4~+CD25~+ and CD8~+CD28~-Tregs,which may be an important mechanism of MM immune evasion,and may be associated with clinical stages,disease progression and prognosis of MM to some extent.