Harada S, Harada Y, Maruyama M, Kajiki A, Kitahara Y, Takamoto M, Ishibashi T
National Ohmuta Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 May;32(5):511-7.
A 58-year-old woman, who had a past history of left upper lobectomy with thoracoplasty for pulmonary tuberculosis and resection of thyroid cancer, was diagnosed as having a mediastinal tumor by chest X-ray examination. It was found to be a malignant thymoma (spindle cell type) after resection. The level of serum gammaglobulin, which had been low before resection, progressively decreased. Afterward, she frequently suffered from airway infections which resulted in severe bronchiecatsis. She died due to respiratory failure 8 years later. In the early stage, though the percentage of pan T cells in peripheral blood lymphocyte subsets was normal, CD4 T cells decreased and CD8 T cells increased. A decrease in helper T cells and an increase in cytotoxic T cells were especially marked. In the late stage, all T cells subsets decreased. In particular, naive T (CD45RA* CD3+ T) cells decreased markedly. However, the percentage of B cells remained normal and that of NK cells was elevated. From the findings of lymphocyte subsets and lymphocyte reactivity to PHA stimulation, it is suggested that T cell dysfunction caused hypogrammaglobulinemia in this case.
一名58岁女性，既往有因肺结核行左上叶肺叶切除术及胸廓成形术和甲状腺癌切除术史，胸部X线检查诊断为纵隔肿瘤。切除后发现为恶性胸腺瘤（梭形细胞型）。术前就较低的血清球蛋白水平进一步下降。此后，她频繁发生气道感染，导致严重支气管扩张。8年后死于呼吸衰竭。早期，外周血淋巴细胞亚群中全T细胞百分比正常，但CD4 T细胞减少，CD8 T细胞增加。辅助性T细胞减少和细胞毒性T细胞增加尤为明显。晚期，所有T细胞亚群均减少。尤其是初始T（CD45RA*CD3+T）细胞明显减少。然而，B细胞百分比保持正常，NK细胞百分比升高。从淋巴细胞亚群及淋巴细胞对PHA刺激的反应性结果来看，提示该病例中T细胞功能障碍导致了低丙种球蛋白血症。
