滤泡调节性T细胞在重症肌无力中的作用研究

发布时间：2018-03-13 01:24

本文选题：重症肌无力　切入点：免疫耐受　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨滤泡调节性T细胞在重症肌无力(MG)发病中的作用。方法：收集2013年一2014年湘雅医院门诊及病房MG患者,并详细记录其临床资料。根据MG患者疾病的严重程度,进行临床MGFA分型及QMG评分。采用流式细胞术检测MG患者及健康对照人群外周血滤泡调节性T细胞(Tfr)、天然调节性T细胞(Treg)及滤泡辅助性T细胞(Tfh)的表达比例,并分析其与临床特征、疾病严重程度的关系及免疫治疗前后的变化。结果：(1)MG患者外周血中Treg细胞的表达较健康人群降低,Tfh细胞的表达增高,Tfr细胞的表达降低,Tfr/Treg及Tfr/Tfh降低,差异均具有统计学意义(P0.05) (2)全身型MG患者外周血中Treg细胞的表达比例高于眼肌型MG患者,Tfh细胞的表达低于眼肌型MG患者,Tfr/Tfh低于眼肌型MG患者,但差异均无统计学意义(P0.05)。与眼肌型MG相比,全身型MG患者Tfr细胞的表达降低,Tfr/Treg降低,差异具有统计学意义(P0.05)。按照MGFA分型的各亚型MG患者中Treg、Tfr、Tfh细胞的表达无明显差异(P0.05)。 (3) Tfr、Treg、Tfh在不同年龄、性别的MG患者外周血中的表达均无显著性差异(P0.05)。与病程小于1年的MG患者相比,病程大于1年的MG患者,Treg、Tfh的表达无显著性差异,而Tfr细胞的表达降低,Tfr/Treg及Tfr/Tfh值减小,差异具有统计学意义(P0.05) (4) Treg、Tfr、Tfh在胸腺正常与胸腺瘤及胸腺增生组的表达水平无显著差异。 (5)与非激素治疗组相比,激素治疗组MG患者外周血中Treg细胞的表达增高,Tfh细胞的表达降低,Tfr细胞的表达增高,Tfr/Tfh的比值增高,差异均具有统计学意义(P0.05)。激素治疗自身前后对比发现,激素治疗后外周血中Treg细胞的表达较治疗前增加,Tfh细胞的表达降低,Tfr细胞的表达增高,差异具有统计学意义(P0.05)。 (6)MG患者QMG评分与外周血中Treg细胞的表达呈负相关,与Tfh细胞的表达呈正相关,与Tfr细胞的表达呈负相关,与Tfr/Treg及Tfr/Tfh均呈负相关,相关系数分别为-0.3840、0.4284、0.5450、-0.3839、-0.6359,有统计学意义(p0.05)。 (7)MG患者外周血中Tfr与Tfh细胞的表达水平无明显相关性,Tfr与Treg细胞存在正相关,相关系数为0.4318,有统计学意义(p0.001)。结论：滤泡调节性T细胞在重症肌无力的发病中具有负性免疫调控作用,其作用可能与天然调节性T细胞、滤泡辅助性T细胞具有一定相关性。
[Abstract]:Objective: to investigate the role of follicular regulatory T cells in the pathogenesis of myasthenia gravis (MG). Methods: the patients with MG in outpatient and ward of Xiangya Hospital from 2013 to 2014 were collected and their clinical data were recorded in detail. Clinical MGFA typing and QMG score were used to detect the expression rate of T cells in peripheral blood follicular regulatory T cells, natural regulatory T cells and follicular helper T cells by flow cytometry in patients with MG and healthy controls. The relationship between the disease and the clinical features, the severity of the disease and the changes before and after immunotherapy were analyzed. Results the expression of Treg cells in the peripheral blood of the patients with MG was significantly lower than that of the healthy controls. The expression of Tfr cells was lower than that of the healthy controls. The expression of Tfr cells was significantly lower than that of the normal controls. There was a significant difference in the expression of Tfr cells and the expression of Tfr cells (P 0.05). (2) the expression of Treg cells in peripheral blood of patients with systemic MG was higher than that of patients with myometrial MG, and the expression of Tfh cells was lower than that of patients with myometric MG, but there was no significant difference in the expression of Tfh and Tfh in patients with myometrial MG, but there was no significant difference in the expression of Tfh cells between patients with myometric MG and those with myometric MG. The expression of Tfr cells was decreased in patients with systemic MG, and the difference was statistically significant (P 0.05). There was no significant difference in the expression of Tfr-Tfr-Tfh cells in all subtypes of MG according to MGFA classification. (3) there was no significant difference in the expression of Tfh in the peripheral blood of MG patients with different age and sex. There was no significant difference in the expression of TregTfh in MG patients with more than 1 year course compared with MG patients with less than one year course. However, the expression of TRF / Treg and Tfr/Tfh in Tfr cells decreased, and the difference was statistically significant (P 0.05). 4) there was no significant difference in the expression of Tfh between normal thymus and thymoma and thymic hyperplasia. (5) compared with the control group, the expression of Treg cells in the peripheral blood of MG patients was increased and the expression of Tfh cells was decreased in the hormone treated group, and the ratio of Tfr / Tfh was increased. The difference was statistically significant (P 0.05). The expression of Treg cells in peripheral blood after hormone therapy was significantly lower than that before and after treatment, and the difference was statistically significant (P 0.05). The QMG score was negatively correlated with the expression of Treg cells in peripheral blood, positively with the expression of Tfh cells, negatively with the expression of Tfr cells, and negatively with Tfr/Treg and Tfr/Tfh. The correlation coefficients were -0.3840, 0.4284- 0.5450- 0.3839-0.3839-0.6359, respectively. There was no significant correlation between the expression of Tfr and Tfh cells in the peripheral blood of patients with MG. There was a positive correlation between Tfr and Treg cells, and the correlation coefficient was 0.4318, which was statistically significant (P 0.001). Conclusion: follicular regulatory T cells play a negative role in the pathogenesis of myasthenia gravis, which may be related to natural regulatory T cells and follicular helper T cells.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R746.1

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