中文摘要：

目的探讨骨髓单个核细胞Coombs（BMMNC—Coombs）试验阳性血细胞减少（又称免疫相关性血细胞减少，IRP）患者骨髓巨噬细胞（Mm）活化抗原表达及其临床意义。方法采用流式细胞仪（FACS）检测61例IRP患者及10例重型再生障碍性贫血（SAA）（病例对照组）和13例正常人（正常对照组）骨髓造血细胞膜自身抗体类型、骨髓M①数量（CD未／CD未）％及Mm活化抗原（CD^69）表达水平（CD68^＋CD69^＋／CD68^＋）％，并探讨其临床意义。结果61例IRP患者其Mm数量及活化抗原表达水平[（0．57±0．30）％和（40．30±18．49）％]均高于病例对照组[（0．46±0．08）％和（32．44±19．37）％]及正常对照组[（0．44±0．69）％和（29．71±11．67）％]（P值均〈0．05）；且其M中数量与活化抗原表达水平呈明显正相关（r=0．89，P〈0．01）。根据Mm数量分为A组（MФ百分率≥0．5％）和B组（Mm百分率〈0．5％），A组34例患者中32例（94．1％）有自身抗体IgG，B组27例患者中仅2例（7．4％）；A组患者骨髓Mm活化抗原表达水平（49．19±16．63）％显著高于B组患者（29．H±14．30）％（P〈0．05），而B组患者和病例对照组及正常组无统计学意义（P值均〉0．05）；A组患者的3、6个月的总有效率（分别为47．06％、79．41％）均明显优于B组患者同期的疗效（22．22％、51．85％）（P〈0．05）；并且A、B组患者6个月的总有效率（79．41％、51．85％）均明显高于3个月的疗效（47．06％、22．22％）（P值均〈0．05）。34例自身抗体IgG（＋）IRP患者按M中数量分为高（≥0．75％）、低（〈0．75％）水平2组，25例M中低水平组24例仅能检测到1系骨髓细胞（CD34^＋或CD15^＋或GlycoA^＋）有自身抗体IgG（96％），1例检测到2系骨髓细胞有自身抗体IgG；9例Mm高水平组有8例能检测到2系骨髓细胞有自身抗体IgG，1例为3系骨髓细胞?

英文摘要：

Objective To explore the expression of antigen activated of macrophages （MФ） of bone marrow and its clinical significance in pancytopenia patients with positive bone marrow mononuclear cells （BMMNC）-Coombs test （immunorelated pancytopenia, IRP）. Methods Sixty-one IRP patients, 10 severe aplastic anemia （SAA） patients and 13 healthy controls were enrolled in this study. The categories of auto-antibodies（ lgG, IgM） on BMMNC（ CD34^＋/CD15^＋/GlycoA^＋ hematocytes）, the quantity （ CD68^＋/CD45^＋） % and expression of antigen activated （ CD69 ） of MФ （ CD68^＋ CD69^＋/CD68^＋ ） % in bone marrow of all cases and controls were measured by fluorescence activated cell sorting（FACS）. Results The quantity and expression ratio of activated antigen of bone marrow （ BM ） MФ in IRP patients [ （ 0. 57 ＋ 0. 30 ） % and （ 40. 30 ± 18.49）% ] were respectively significantly higher than those in SAA [ （0.46±0. 08）% and （32. 44 ± 19.37）%] and healthy controls [（0.44 ±0.69）% and （29.71 ±11.67）%] （both P 〈0.05）. The quantity presented high-positive correlation with the expression ratio of activated antigen of BM MФ （ r = 0. 89, P 〈 0. 01 ）. Patients with IRP were classified into two subgroups according to the quantity of MФ： Group A （MФ≥0. 5%, 34 cases） and Group B （MФ≤ 0. 5%, 27 cases）. Thirty-two cases （94. 12% ） were with auto antibody （IgG） in Group A, while only 2 （7.41%） with auto antibody （IgG） in Group B. There was significant difference in expression ratio of activated antigen of BM MФ between Group A （49. 19 ± 16. 63 ） % and Group B （ 29. 11 ± 14. 30 ） % （ P 〈 0. 05 ）, but no difference was found between Group B and the control group （ P 〉0. 05）. Total curative rates at 3 and 6 month （47.06% and 79.41% ） of Group A were better than those of Group B （22.22% and 51.85% ）. Thirty-four IRP patients with autoantibody （IgG） （ ＋ ） were divided into two subgroups ac