不同分期慢性淋巴细胞白血病患者淋巴细胞亚群特点及氟达拉滨对其的影响

 目的　探讨不同分期的慢性淋巴细胞白血病（CLL）患者的外周血淋巴细胞亚群特点以及应用以氟达拉滨为基础的化疗方案治疗前后淋巴细胞亚群的变化。方法　应用流式细胞术检测CLL患者以氟达拉滨为基础的化疗方案治疗前后外周血的T淋巴细胞亚群、NK细胞亚群并以健康人作对照。结果　CLL患者总T细胞、T辅助细胞（CD4），CD4／CD8比值均低于健康人，Ⅲ～Ⅳ期患者尤为突出（P＜0.01），0～Ⅱ期患者NK细胞略高于健康人（P＞0.05），Ⅲ～Ⅳ期患者明显低于健康人（P＜0.05）。予以氟达拉滨为主的化疗方案治疗4个周期后，CLL患者总T细胞、T辅助细胞，CD4／CD8比值均较治疗前显著升高（P＜0.01），NK细胞亦明显升高（P＜0.05）。结论　CLL患者存在细胞免疫调节异常，且机体免疫功能与疾病状态密切相关。观察CLL患者外周血T淋巴细胞亚群及NK细胞的比例有助于医生对病情的判断，还可作为CLL患者疗效判断的一项指标。氟达拉滨治疗有效的CLL患者细胞免疫功能明显改善，其在化疗后短时间内是否存在显著的免疫抑制还有待于进一步的临床观察。

Clinical study on features of subgroup of lymphocyte from different staging patients with chronic lymphocytic leukemia and the influence of fludarabine

Objective To study the feature of the subgroup of lyrnphocytes from patients with chronic lymphocytic leukemia(CLL)at different stages,and the changes in the treatment by the chemotherapy based on fludarabine.Methods The subgroup of T lyrnphocytes and NK cell were detected by flow cytometry during treatment which based on fludarabine from patients with CLL and normal people.Results The total of T.help T cells and ratio of CD4/CD8 of patients were significantly lower than that in normal people,especially in stage Ⅲ-Ⅳ(P＜0.01),and the NK cells in stage 0～Ⅱis higher than that in normal(P＞0.05),which is lower in stage Ⅲ-Ⅳ(P＜0.05).Four weeks after the chemotherapy mainly based on fludarabine,the total T,help T cell and ratio of CD4/CD8 of patients with CLL was significantly raised(P＜0.01),and meanwhile the NK cell was clearly raised (P＜0.05).Conclusion The cell mediated immunological regulation abnormal exists in patients with CLL,and the immune function correlated closely with the morbid state.Observation on the changes of T lymphocyte subsets and its ratio of NK cells,which were is helpful for the assement of the patient's condition,and also can evaluate the therapeutic effect.The cellular immune function was obviously improved in patients who are effective to fludarabine.whether there exists noticeable immune suppression shortly after chemotherapy should be studied in further clinical observation.