CD55、CD59联合嗜水气单胞菌毒素变异体检测对PNH的诊断价值

doi:10.3969/j.issn.1673-8640.2020.06.011

摘要/Abstract

摘要：

目的检测各类贫血患者CD55、CD59和嗜水气单胞菌毒素变异体（FLAER）的表达情况,评价CD55、CD59联合FLAER检测对阵发性睡眠性血红蛋白尿症（PNH）的诊断价值。方法选取贫血住院患者157例,其中缺铁性贫血（IDA）38例、巨幼细胞性贫血（MA）23例、骨髓增生异常综合征（MDS）27例、再生障碍性贫血（AA）25例、自身免疫溶血性贫血（AIHA）31例、PNH 13例。另选取体检健康者20名,作为正常对照组。检测所有研究对象红细胞和粒细胞CD55、CD59以及粒细胞和单核细胞FLAER的表达情况。结果 PNH组红细胞和粒细胞CD55^-、CD59^-百分比与正常对照组比较差异有统计学意义（P<0.05）。PNH组粒细胞和单核细胞FLAER^-百分比均>50%,显著高于红细胞和粒细胞CD55^-、CD59^-百分比（P<0.05）。CD55、CD59与FLAER检测对PNH诊断的符合率为100%。有3例AA患者和2例MDS患者FLAER表达缺失,而CD55、CD59表达正常;有2例AIHA患者红细胞CD55、CD59表达部分缺失,粒细胞CD55、CD59表达正常,FLAER表达正常。结论 CD55、CD59表达缺陷是PNH的主要特征,CD55、CD59联合FLAER检测在PNH诊断及鉴别诊断中有着重要的价值。

关键词: CD55, CD59, 嗜水气单胞菌毒素变异体, 贫血, 阵发性睡眠性血红蛋白尿症

Abstract:

Objective To determine the expressions of CD55,CD59 and fluorescent aerolysin（FLAER） of anemia patients,and to evaluate the role of CD55,CD59 and FLAER combined determination for the diagnosis of paroxysmal nocturnal hemoglobinuria（PNH）. Methods A total of 157 inpatients,including 38 patients with iron deficiency anemia（IDA）,23 patients with megaloblastic anemia（MA）,27 patients with myelodysplastic syndrome（MDS）,25 patients with aplastic anemia（AA）,31 patients with autoimmune hemolytic anemia（AIAH） and 13 patients with PNH,were enrolled. Totally,20 healthy subjects were enrolled as control group. Erythrocyte and granulocyte CD55,CD59 and granulocyte and monocyte FLAER were determined. Results Erythrocyte and granulocyte CD55^- and CD59^- percentages in PNH group had statistical significance compared with control group（P<0.05）. In PNH group,granulocyte and monocyte FLAER^- percentages were >50%,which were higher than erythrocyte and granulocyte CD55^- and CD59^- percentages（P<0.05）. The consistency rate of CD55,CD59 and FLAER determinations was 100%. There were 3 AA patients and 2 MDS patients with FLAER deletion and normal CD55 and CD59 expressions. There were 2 AIHA patients with partial erythrocyte CD55 and CD59 deletion and normal granulocyte CD55 and CD59 and FLAER expression. Conclusions CD55 and CD59 expression defects are the main characteristics of PNH,and FLAER determination combined with CD55 and CD59 plays a role in the diagnosis and differential diagnosis of PNH.

Key words: CD55, CD59, Fluorescent aerolysin, Anemia, Paroxysmal nocturnal hemoglobinuria

中图分类号:

R446.1

鲁家才, 黄莹, 莫扬, 周小芬, 姚欣. CD55、CD59联合嗜水气单胞菌毒素变异体检测对PNH的诊断价值[J]. 检验医学, 2020, 35(6): 566-569.

LU Jiacai, HUANG Ying, MO Yang, ZHOU Xiaofen, YAO Xin. Role of CD55,CD59 and FLAER combined determination for the diagnosis of PNH[J]. Laboratory Medicine, 2020, 35(6): 566-569.

图/表 3

参考文献 12

[1]	陈雪,张阳. 阵发性睡眠性血红蛋白尿症发病机制、诊断及治疗进展[J]. 白血病·淋巴瘤,2016,25(4):252-256.
[2]	鲁家才,黄莹,莫扬. 外周血红细胞和中性粒细胞CD55/CD59表达在贫血诊断中的意义[J]. 细胞与分子免疫学杂志,2014,30(4):424-425.
[3]	孙莺心,何广胜. 阵发性睡眠性血红蛋白尿症诊治现状与展望[J]. 中国实验血液学杂志,2012,20(5):1267-1271.
[4]	张之南,沈悌. 血液病学[M]. 北京:科学技术出版社,2012.
[5]	杨柯,郭晓宇,欧剑锋,等. 外周血粒细胞CD55,CD59和FLAER检测在贫血及PNH诊断中的意义[J]. 现代检验医学杂志,2017,32(3):6-10.
[6]	RISITANO A M.Paroxysmal nocturnal hemoglobinuria and the complement system:recent insights and novel anticomplement strategies[J]. Atv Exp Med Biol,2013,735:155-172.
[7]	张静,李星鑫,施均,等. 伴PNH克隆的获得性再生障碍性贫血临床特征及PNH克隆演变分析[J]. 中华血液学杂志,2016,37(2):124-129.
[8]	CORREIA R P,BENTO L C,BORTOLUCCI A C,et al.Technical advances in flow cytometry-based diagnosis and monitoring of paroxysmal nocturnal hemoglobinuria[J]. Einstein(Sao Paulo),2016,14(3):366-373.
[9]	李艳,秦铁军,徐泽锋,等. 伴PNH克隆的骨髓增生异常综合征患者临床和实验室特征分析[J]. 中华血液学杂志,2016,37(4):313-317.
[10]	谢小望,李辉,鹿晓煜,等. 低剂量HA方案治疗难治性、复发性AA-PNH综合症1例并文献复习[J]. 临床血液学杂志,2015,28(6):996-998.
[11]	KULAGIN A,LISUKOV I,IVANOVA M,et al.Prognostic value of paroxysmal nocturnal haemoglobinuria clone presence in aplastic anaemia patients treated with combined immunosuppression:results of two-centre prospective study[J]. Br J Haematol,2014,164(4):546-554.
[12]	SCHEINBERG P,MARTE M,NUNEZ O,et al.Paroxysmal nocturnal hemoglobinuria clones in severe aplastic anemia patients treated with horse anti-thymocyte globulin plus cyclosporine[J]. Haemotologic,2010,95(7):1075-1080.

组别	例数	红细胞CD55^-	红细胞CD59^-	粒细胞CD55^-	粒细胞CD59^-	粒细胞FLAER^-	单核细胞FLAER^-
IDA组	38	3.61±1.63	2.22±1.97	2.24±1.47	2.71±2.80	0.02±0.03	0.03±0.02
MA组	23	3.32±1.31	2.46±1.89	2.35±1.77	2.51±0.90	0.03±0.02	0.03±0.02
MDS组	27	4.41±3.63	3.55±4.57	6.53±11.31	3.65±3.76	2.13±7.11	0.73±1.31
AA组	25	5.41±8.33	4.64±3.45	5.90±8.65	6.19±7.34	6.54±5.20	6.51±4.16
AIHA组	31	5.53±4.12	4.07±5.41	1.65±1.31	2.17±1.35	0.05±0.04	0.03±0.02
PNH组	13	27.52±15.50^*	28.65±14.55^*	45.10±15.20^*	47.30±14.20^*	75.10±20.30^#	71.32±15.20^#
正常对照组	20	3.63±2.24	1.43±1.94	2.07±1.47	2.78±2.27	0.02±0.02	0.17±0.12

组别	例数	红细胞CD55^-	红细胞CD59^-	粒细胞CD55^-	粒细胞CD59^-	粒细胞FLAER^-	单核细胞FLAER^-
IDA组	38	3.61±1.63	2.22±1.97	2.24±1.47	2.71±2.80	0.02±0.03	0.03±0.02
MA组	23	3.32±1.31	2.46±1.89	2.35±1.77	2.51±0.90	0.03±0.02	0.03±0.02
MDS组	27	4.41±3.63	3.55±4.57	6.53±11.31	3.65±3.76	2.13±7.11	0.73±1.31
AA组	25	5.41±8.33	4.64±3.45	5.90±8.65	6.19±7.34	6.54±5.20	6.51±4.16
AIHA组	31	5.53±4.12	4.07±5.41	1.65±1.31	2.17±1.35	0.05±0.04	0.03±0.02
PNH组	13	27.52±15.50^*	28.65±14.55^*	45.10±15.20^*	47.30±14.20^*	75.10±20.30^#	71.32±15.20^#
正常对照组	20	3.63±2.24	1.43±1.94	2.07±1.47	2.78±2.27	0.02±0.02	0.17±0.12

组别	例数	红细胞CD55^-	红细胞CD59^-	粒细胞CD55^-	粒细胞CD59^-
MDS组	2	6.73±4.34	2.41±4.89	6.82±7.34	4.60±4.28
AA组	4	9.77±5.57	5.75±3.44	10.86±7.65	12.73±5.57
AIHA组	2	12.36±6.72	9.12±8.15	1.67±1.28	2.16±1.57
PNH组	13	27.52±15.50	28.65±14.55	45.1±15.20^*	47.30±14.20^#

组别	例数	红细胞CD55^-	红细胞CD59^-	粒细胞CD55^-	粒细胞CD59^-
MDS组	2	6.73±4.34	2.41±4.89	6.82±7.34	4.60±4.28
AA组	4	9.77±5.57	5.75±3.44	10.86±7.65	12.73±5.57
AIHA组	2	12.36±6.72	9.12±8.15	1.67±1.28	2.16±1.57
PNH组	13	27.52±15.50	28.65±14.55	45.1±15.20^*	47.30±14.20^#

组别	例数	粒细胞FLAER^-	单核细胞FLAER^-
MDS组	4	2.67±0.87	2.54±0.85
AA组	7	6.70±4.16^*	6.31±4.03^*
PNH组	13	75.10±20.30	71.32±15.20