The Change And Its Clinical Significance Of CD4~+T Cell Subset In AA, MDS And AML Patients

OBJECTIVE To investigate the change of CD4+T cell subset in the role of immune pathogenesis of aplastic anemia(AA)、myelodysplastic syndromes (MDS)、acute myeloid leukemia(AML) patients.METHODS Peripheral Blood Mononuclear Cell (PBMC) were collected from85patients between June2010and June2011from the Department of H ematology, Provincial Hospital affiliated to Shandong Uneiversity. The85cases consist of48MDS, including22refractory anemia and26refractory anemia with excess blasts,25AA,12AML patients.8healthy individuals (non-hemat ologic patients) were used as normal control. By FACS, the proportion of T h elper cells and Treg cells in peripheral blood mononuclear cells were detected in these cases to evaluate the status of cellular immune.RESULTS1. Compared with the control group, the percentage of Th1、Th17cells a nd Th1/Th2were significantly higher and the percentage of Th2and Treg eel Is were lower in AA (P<0.05); There were no difference in the percentage of Th1、Th2、Treg cells and Thl/Th2between MDS and control groups(P>0.05), but the percentage of Thl7was higher than control groups(P<0.05); The per centage of Th1、Th17cells and Thl/Th2were significantly higher and the p ercentage of Th2cells were lower in MDS-RA, but there was no difference in the percentage of Treg cells between MDS-RA and control groups(P>0.05). In AML and MDS-RAEB, the percentage of Th1、Th17cells and Th1/Th2we re significantly lower and the percentage of Th2and Treg cells were higher t han healthy donors(P<0.05)..2. The percentage of Th2and Treg cells were higher in MDS-RA group(P <0.05) than the AA group,but there were no difference in Th1、Th17cells a nd Thl/Th2between AA group and MDS-RA group(P>0.05).3. Compared to the MDS-RA group, the percentage of Th1、Thl7cells an d Thl/Th2were lower and the percentage of Th2and Treg cells were higher i n MDS-RAEB.4. Compared to the MDS-RAEB group, the percentage of Thl cells was1ower and the percentage of Th2and Treg cells were higher in AML, however, there were no difference in Thl7cells and Thl/Th2CONCLUSIONS1. This study suggests the status of immune is not the same in AA、varia nt stages of MDS and AML. The ratio of Thl cells、Th17cells and Th1/Th2were significantly increased, while the ratio of Th2cells and Treg cells were reduced in patients with aplastic anemia. That means in AA patients, the cyto kines which have anti-tumor effect increased while the immunosuppressive cyto kines decreased. That means in AA patients, the anti-tumor immunity played a major role, and the excessive apoptosis mediated by immune factors lead to t he bone marrow failure.2. There were no difference in the percentage of Th1、Th2、Treg cells and Thl/Th2between MDS and control groups(P>0.05), but the percentage of Thl7was higher than control groups. To further analysis the patients we found that in MDS-RA, the percentage of Th1、Th17cells and Thl/Th2were significan tly higher and the percentage of Th2cells were lower. While in MDS-RAEB patients, the percentage of Th1、Th17cells and Thl/Th2were significantly lo wer and the percentage of Th2and Treg cells were higher than healthy donors. That means in MDS patients, the status of immune is not same, In MDS-RA patients, like as AA patients, the anti-tumor immunity played a major role and lead to the excessive apoptpsis then to the bone marrow failue. While in MD S-RAEB patients, The immunosuppressive factors increased in these patients. In these patients, the anti-tumor immunity did not play the major role, so it caus e the immune escape, and the main reason of the bone marrow failure is the1arge accumulation of abnormal clone.3. As same as the MDS-RAEB patients, in the AML patients, the percenta ge of Th1、Th17cells and Thl/Th2were significantly reduced and the percen tage of Th2and Treg cells were increased, and the balance of Th1/Th2shifted to Th2. This means that in AML patients, like as MDS-RAEB patients, the r eason of the bone marrow failure is also the large accumulation of abnormal c lone.