Th17细胞的异质性在骨髓增生异常肿瘤中的临床意义

doi:10.11958/20250670

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 942-945.doi: 10.11958/20250670

Th17细胞的异质性在骨髓增生异常肿瘤中的临床意义

王怡晨¹(), 周文广¹, 严燕雯¹, 易芳¹, 秦玲莎², 黎炜², 李玉权¹, 曾祥宗¹^,^△()

1 广州医科大学附属清远医院（清远市人民医院）血液病科（邮编511518）
2 广州医科大学附属清远医院（清远市人民医院）生物样本资源中心（邮编511518）

收稿日期:2025-02-19 修回日期:2025-07-15 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：gdzxz1990@163.com
作者简介:王怡晨（1997），女，医师，主要从事MDS向AML转化机制方面研究。E-mail：wangyichen199712@163.com
基金资助:
广东省医学科学技术研究基金(A2024072)

The clinical significance of Th17 cell heterogeneity in myelodysplastic neoplasms

WANG Yichen¹(), ZHOU Wenguang¹, YAN Yanwen¹, YI Fang¹, QIN Lingsha², LI Wei², LI Yuquan¹, ZENG Xiangzong¹^,^△()

1 Department of Hematology, Affiliated Qingyuan Hospital of Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan 511518, China
2 Biological Sample Resource Center, Affiliated Qingyuan Hospital of Guangzhou Medical University (Qingyuan People's Hospital), Qingyuan 511518, China

Received:2025-02-19 Revised:2025-07-15 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: gdzxz1990@163.com

王怡晨, 周文广, 严燕雯, 易芳, 秦玲莎, 黎炜, 李玉权, 曾祥宗. Th17细胞的异质性在骨髓增生异常肿瘤中的临床意义[J]. 天津医药, 2025, 53(9): 942-945.

WANG Yichen, ZHOU Wenguang, YAN Yanwen, YI Fang, QIN Lingsha, LI Wei, LI Yuquan, ZENG Xiangzong. The clinical significance of Th17 cell heterogeneity in myelodysplastic neoplasms[J]. Tianjin Medical Journal, 2025, 53(9): 942-945.

摘要/Abstract

摘要：

目的探讨骨髓增生异常肿瘤（MDS）患者骨髓中Th17细胞、Th1样Th17细胞和转录因子叉头框蛋白P3（FoxP3）⁺Th17细胞的比例及骨髓上清液白细胞介素-17A（IL-17A）的表达及其临床意义。方法选取MDS患者（MDS组）40例和营养不良性贫血患者（对照组）18例。MDS患者根据形态学定义亚型，低原始细胞（MDS-LB）组19例；原始细胞增多型（MDS-IB）组21例，其中IB1型11例、IB2型10例。参照修订版国际预后评分标准（IPSS-R）对MDS患者进行评分，≤4.5分为低危组（18例），>4.5为高危组（22例）。采用流式细胞术检测MDS组和对照组的骨髓Th17细胞、Th1样Th17细胞和FoxP3⁺Th17细胞的比例；酶联免疫吸附试验（ELISA）检测上述样本中骨髓上清液的IL-17A水平。结果 MDS患者Th17细胞比例及IL-17A的水平高于对照组（P<0.05）。根据IL-17A的中位表达水平将MDS组分为低表达组（<13.71 ng/L，20例）和高表达组（≥13.71 ng/L，20例）。与低表达组相比，高表达组出现原始细胞比例<5%和低危患者的比例较高（P<0.05）。与低危患者相比，高危患者的Th17细胞比例、IL-17A水平及Th1样Th17细胞比例下降，FoxP3⁺Th17细胞的比例升高（P<0.05）。与MDS-LB相比，MDS-IB组的Th17细胞比例、IL-17A水平及Th1样Th17细胞比例下降，FoxP3⁺Th17细胞的比例升高（P<0.05）。结论 MDS患者Th17细胞比例和IL-17A的水平均明显升高。Th1样Th17细胞比例下降，FoxP3⁺Th17细胞比例升高可能与患者原始细胞比例增多及较高的危险分层有关。

关键词: Th17细胞, 异质性, 白细胞介素17, 骨髓增生异常肿瘤

Abstract:

Objective To investigate the proportion of Th17 cells, Th1-like Th17 cells and FoxP3⁺Th17 cells in bone marrow of patients with myelodysplastic syndrome (MDS), the expression of interleukin-17A (IL-17A) in bone marrow supernatant and its clinical significance. Methods Forty MDS patients (MDS group) and 18 patients with nutritional anemia (control group) were selected. MDS patients were classified into the low blast (MDS-LB) group (19 cases) and the increased blast (MDS-IB) group (21 cases, including 11 cases of type IB1 and 10 cases of type IB2) based on morphological definition. The MDS patients were scored according to the revised International Prognostic Scoring System (IPSS-R), with 18 cases in the low-risk group (≤4.5) and 22 cases in the high-risk group (>4.5). Flow cytometry was used to detect the proportion of Th17 cells, Th1-like Th17 cells and FoxP3⁺Th17 cells in bone marrow of the MDS group and the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of IL-17A in bone marrow supernatant of the above samples. Results The proportion of Th17 cells and the level of IL-17A were higher in patients of the MDS group than those in the control group (P<0.05). According to the median expression level of IL-17A, the MDS group was divided into the low-expression group (<13.71 ng/L, 20 cases) and the high-expression group (≥13.71 ng/L, 20 cases). Compared with the low-expression group, there were higher proportion of patients with blast cells <5% and low-risk patients (P<0.05) in the high-expression group. Compared with the IL-17A low-expression group, the IL-17A high-expression group had a higher proportion of patients with blast cells <5% and relatively low-risk patients (P<0.05). Compared with the low-risk patients, high-risk patients had a lower proportion of Th17 cells, IL-17A levels and Th1-like Th17 cells, and a higher proportion of FoxP3⁺Th17 cells (P<0.05). Compared with the MDS-LB group, the MDS-IB group had a lower proportion of Th17 cells, IL-17A levels and Th1-like Th17 cells, and a higher proportion of FoxP3⁺Th17 cells (P<0.05). Conclusion The proportion of Th17 cells and the level of IL-17A are significantly increased in MDS patients. The decreased proportion of Th1-like Th17 cells and the increased proportion of FoxP3⁺Th17 cells may be related to the increased proportion of blast cells and higher risk stratification in patients.

Key words: Th17 cells, heteroplasmy, interleukin-17, myelodysplastic neoplasms

中图分类号:

R551.3

图/表 5

表1 骨髓上清液不同IL-17A水平表达组的临床特征比较[例（%）]

Tab.1 Comparison of clinical characteristics between the two groups of different levels of IL-17A expression in bone marrow supernatant

组别	n	原始细胞比例		危险度
组别	n	<5%	≥5%	低危	高危
低表达组	20	4（20.0）	16（80.0）	5（25.0）	15（75.0）
高表达组	20	15（75.0）	5（25.0）	13（65.0）	7（35.0）
χ²		12.130^＊＊		6.465^＊

表2 不同危险度MDS组的Th17细胞比例及IL-17A水平比较 [M（P25，P75）]

Tab.2 Comparison of the proportion of Th17 cells and the level of IL-17A between the two groups of different risk MDS

组别	n	Th17细胞/%	IL-17A/（ng/L）
低危组	18	3.04（2.27，4.25）	18.72（11.30，21.98）
高危组	22	2.01（1.13，2.63）	12.27（7.42，14.84）
Z		2.719^＊＊	2.542^＊

表3 不同亚型MDS组的Th17细胞比例及IL-17A水平比较[M（P25，P75）]

Tab.3 Comparison of the proportion of Th17 cells and the level of IL-17A between the two groups of different subtypes of MDS

组别	n	Th17细胞/%	IL-17A/（ng/L）
MDS-LB组	19	3.25（2.31，4.11）	18.31（13.73，21.90）
MDS-IB组	21	1.83（1.07，2.47）	9.92（6.91，13.98）
Z		3.291^＊＊	3.277^＊＊

表4 不同危险度MDS组的骨髓Th1样Th17细胞和FoxP3+ Th17细胞的比例比较[M（P25，P75）]

Tab.4 Comparison of the proportion of bone marrow Th1-like Th17 cells and FoxP3+ Th17 cells between the two groups of different subtypes of MDS groups

组别	n	Th样Th17细胞/%	FoxP3⁺Th17细胞/%
低危组	18	22.80（12.33，36.78）	9.15（8.01，13.53）
高危组	22	12.10（8.01，16.78）	17.00（12.48，23.75）
Z		2.977^＊＊	3.100^＊＊

表5 不同亚型MDS组的骨髓Th1样Th17细胞和FoxP3+ Th17细胞的比例比较[M（P25，P75）]

Tab.5 Comparison of the proportion of bone marrow Th1-like Th17 cells and FoxP3+ Th17 cells between the two groups of different subtypes of MDS

组别	n	Th1样Th17细胞/%	FoxP3⁺Th17细胞/%
MDS-LB组	19	22.20（11.80，36.40）	11.80（8.22，12.90）
MDS-IB组	21	12.10（8.71，16.85）	20.80（13.25，27.90）
Z		2.600^＊＊	3.440^＊＊

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Th17细胞的异质性在骨髓增生异常肿瘤中的临床意义

The clinical significance of Th17 cell heterogeneity in myelodysplastic neoplasms

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