Wang Yi-hao, Fu Rong, Shao Zong-hong, Wang Hua-quan, Xing Li-min, Liu Hong, Wu Yu-hong, Li Li-juan, Liu Hui, Wang Jun, Chen Jin, Wang Hong-lei
Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
Zhonghua Xue Ye Xue Za Zhi. 2009 Aug;30(8):538-42.
To explore the quantity and function of bone marrow (BM) macrophages in patients with BMMNC-Coombs Test(+) pancytopenia (BCTP).
Sixty-one patients with BCTP, 10 with severe aplastic anemia (SAA) and 13 normal controls were enrolled in this study. The quantity of BM macrophages was measured by FACS and their function was evaluated by phagocytosis test.
The number of macrophages, phagocytosis ratio and index of cock's red blood cells (CRBC) in BCTP patients were (0.57 +/- 0.30)%, (37.56 +/- 15.20)%, and 0.75 +/- 0.34, respectively, being significantly higher than those in SAA group [0.46 +/- 0.08)%, (28.26 +/- 10.46)%, and in 0.59 +/- 0.39] and in normal control [0.44 +/- 0.69)% (25.63 +/- 14.75)%, and 0.55 +/- 0.16] (P < 0.05). The BCTP patients were classified into two subgroups according to the quantity of macrophages: Group A (M(Phi) > or = 0.5%, 34 cases) and Group B (M(Phi) < 0.5%, 27 cases). There were 32 cases (94.12%) with BMMNC-IgG(+) in Group A and only 2 cases (7.41%) in Group B. There were significant differences in phagocytosis ratio and index of macrophages between Group A [46.62 +/- 13.38)% and 0.91 +/- 0.36] and Group B [(28.67 +/- 12.59)% and 0.61 +/- 0.30] (P < 0.05), while no statistical differences between group B and other two control groups (P > 0.05). Thirty-four BMMNC-IgG(+) patients were further divided into two subgroups: High level (HL) group [> or = 0.75%, 9 cases (26.47%)] and Low level (LL) group [< 0.75%, 25 cases (73.53%)]. Only one lineage of BMMNC-IgG could be detected in LL group. Among 9 patients in HL group, 8(23.53%) had two lineages of BMMNC-IgG and 1(2.94%) had three lineages. Phagocytosis ratio and index of macrophages were significantly higher in HL group [(60.22 +/- 12.51)% and 1.23 +/- 0.23] than in LL group [(43.32 +/- 9.24)% and 0.84 +/- 0.24] (P < 0.05). The level of peripheral blood(PB) RBC, HGB and PLT in HL group were significantly lower than in LL group (P < 0.05), while the percentage of Ret, the level of TBIL and the ratio of erythroid of sternal BM in HL group were significantly higher than in LL group (P < 0.05).
More quantity and stronger function of macrophages are observed in BCTP patients with BMMNC-IgG(+). One of the mechanism of hematocytopenia might be that macrophages activated by IgG autoantibodies phagocytose hematopoietic cells in BM. Macrophages do not involve in damage process of BM in BCTP with IgM or cold autoantibodies.
探讨骨髓单个核细胞抗人球蛋白试验（BMMNC-Coombs Test）阳性的全血细胞减少症（BCTP）患者骨髓巨噬细胞的数量及功能。
本研究纳入61例BCTP患者、10例重型再生障碍性贫血（SAA）患者及13名正常对照者。采用流式细胞术检测骨髓巨噬细胞数量，通过吞噬试验评估其功能。
BCTP患者巨噬细胞数量、吞噬率及鸡红细胞（CRBC）吞噬指数分别为（0.57±0.30）%、（37.56±15.20）%和0.75±0.34，显著高于SAA组[（0.46±0.08）%、（28.26±10.46）%和0.59±0.39]及正常对照组[（0.44±0.69）%、（25.63±14.75）%和0.55±0.16]（P<0.05）。根据巨噬细胞数量将BCTP患者分为两个亚组：A组（M(Φ)≥0.5%，34例）和B组（M(Φ)<0.5%，27例）。A组BMMNC-IgG(+)有32例（94.12%），B组仅有2例（7.41%）。A组[（46.62±13.38）%和0.91±0.36]与B组[（28.67±12.59）%和0.61±0.30]巨噬细胞吞噬率及吞噬指数差异有统计学意义（P<0.05），而B组与其他两个对照组之间无统计学差异（P>0.05）。34例BMMNC-IgG(+)患者进一步分为两个亚组：高水平（HL）组[≥0.75%，9例（26.47%）]和低水平（LL）组[<0.75%，25例（73.53%）]。LL组仅能检测到一种BMMNC-IgG谱系。HL组9例患者中，8例（23.53%）有两种BMMNC-IgG谱系，1例（2.94%）有三种BMMNC-IgG谱系。HL组巨噬细胞吞噬率及吞噬指数[（60.22±12.51）%和1.23±0.23]显著高于LL组[（43.32±9.24）%和0.84±0.24]（P<0.05）。HL组外周血红细胞（RBC）、血红蛋白（HGB）及血小板（PLT）水平显著低于LL组（P<0.05），而HL组网织红细胞百分比（Ret）、总胆红素（TBIL）水平及胸骨骨髓红系比例显著高于LL组（P<0.05）。
BMMNC-IgG(+)的BCTP患者巨噬细胞数量更多、功能更强。血细胞减少的机制之一可能是IgG自身抗体激活的巨噬细胞吞噬骨髓中的造血细胞。巨噬细胞不参与IgM或冷自身抗体所致BCTP患者的骨髓损伤过程。
