Tfh细胞及其分泌的IL-21、IFN-γ在慢性淋巴细胞白血病中的表达及临床意义

Expression and Clinical Significance of Tfh Cells and IL-21, IFN-γ Secreted by It in Chronic Lymphocytic Leukemia

摘要: 目的：探讨Tfh细胞及其分泌的细胞因子IL-21、IFN-γ在慢性淋巴细胞白血病(CLL)中的表达及临床相关诊断、预后意义。方法：选取2022年12月至2023年6月期间于新疆医科大学第一附属医院血液科住院接受治疗的30例CLL患者作为研究对象，选取同期健康体检者20例设为对照组。收集两组患者外周血，用流式细胞术胞内染色法检测Tfh细胞比例及其IL-21、IFN-γ表达水平。比较IL-21 IFN-γ⁻Tfh/Tfh (%)、IL-21⁻IFN-γ Tfh/Tfh (%)、IL-21 IFN-γ Tfh/Tfh (%)在两组间的差异。结合临床资料比较Tfh细胞表达IL-21、IFN-γ水平在不同CLL临床指标分组、预后分期间的不同。结果：CLL组的Tfh细胞比例、IL-21 IFN-γ⁻Tfh/Tfh (%)、IL-21 IFN-γ Tfh/Tfh (%)均高于HC组(P < 0.05)；CLL组内比较，CLL患者淋巴细胞高于均值组和淋巴结肿大组外周血中IL-21 IFN-γ⁻Tfh/Tfh细胞比例均较高(P < 0.05)；无IGVH突变的CLL患者外周血中IL-21 IFN-γ⁻Tfh/Tfh细胞比例高于IGVH突变CLL患者(P < 0.05)；IPI指数高危、极高危组的CLL患者外周血IL-21 IFN-γ Tfh/Tfh细胞比例高于IPI指数低危、中危组(P < 0.05)；结论：Tfh细胞在CLL患者外周血中表达异常升高，其分泌的IL-21、IFN-γ水平更高，并与疾病分期、临床高危指标存在相关性。异常的Tfh细胞、IL-21水平累积可能有助于支持CLL细胞的增殖，参与CLL的免疫发病机制。

Abstract: Objective: To investigate the expression of Tfh cells and cytokines IL-21 and IFN-γ secreted by it in chronic lymphocytic leukemia (CLL), as well as their significance in different clinical indicators of CLL. Methods: 30 CLL patients who were treated in the First Affiliated Hospital of Xinjiang Medical University from December 2022 to June 2023 were selected as the case group, and the control group was 20 healthy volunteers who underwent physical examination in the same period. The percentage of Tfh cells and levels of IL-21, IFN-γ in peripheral blood was detected by flow cytometry; Compare the differences between IL-21 IFN-γ⁻Tfh/Tfh (%), IL-21⁻IFN-γ Tfh/Tfh (%), and IL-21 IFN-γ Tfh/Tfh (%) between the two groups. Comparing the expression levels of IL-21 and IFN-γ secreted by Tfh cells in different CLL clinical indicator groups and prognostic stages. Results: The proportion of Tfh, IL-21 IFN-γ⁻Tfh/Tfh (%) and IL-21 IFN-γ Tfh/Tfh (%) in CLL group were higher than those in control group (P < 0.05). In CLL group, the proportion of IL-21 IFN-γ⁻Tfh/Tfh in CLL patients with higher lymphocytes and lymph node enlargement groups was elevated (P < 0.05); The proportion of IL-21 IFN-γ⁻Tfh/Tfh cells in CLL patients without IGVH mutations was higher than that in CLL patients with IGVH mutations (P < 0.05); The proportion of IL-21 IFN-γ Tfh/Tfh of CLL patients in the IPI index high-risk and extremely high-risk groups was higher than that in the low-risk and medium risk groups (P < 0.05). Conclusion: Tfh cells abnormally elevated in the peripheral blood of CLL patients, with higher levels of IL-21 and IFN-γ secretion, which were correlated with disease staging, and clinical high-risk indicators. Abnormal accumulation of Tfh cells and IL-21 levels may be involved the proliferation of CLL cells and participate in the immune pathogenesis of CLL.