Immunological system status and the appearance of respiratory system disturbances in thymectomized patients.
Immunological system status and the appearance of respiratory system disturbances in thymectomized patients.
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免疫系统状态和胸膜切除患者呼吸系统障碍的出现。
DOI：
10.1007/s00005-007-0004-z
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发表时间：
2007-01
影响因子：
3.2
通讯作者：
Milanowski, Janusz
中科院分区：
文献类型：
--
作者：
Krawczyk, Pawel;Adamczyk-Korbel, Marta;Kieszko, Robert;Korobowicz, Elzbieta;Milanowski, Janusz
成人发病的胸腺瘤可能导致多种疾病，如纯红细胞发育不全、重症肌无力和免疫缺陷（古德氏综合征）。胸腺切除术并不总能改善病人的病情，甚至可能产生额外的症状。其发病机制尚不完全清楚，但最常提出的是自身免疫过程和骨髓缺损。11例胸腺瘤患者（平均年龄：56.2±15.5岁）在胸腺瘤切除术后6个月至10年进行了分析，25例健康人作为对照。采用酶联免疫吸附试验（ELISA）和流式细胞术技术评价受试者的免疫状态。1例诊断为Good’s综合征，4例出现重症肌无力，9例出现上呼吸道和下呼吸道反复感染。免疫分析（ELISA和流式细胞术）显示，胸腺切除患者的IgG水平（p < 0.05）、外周血B淋巴细胞百分比（p < 0.0005）和CD4:CD8比值（p < 0.05）明显低于正常对照组。胸腺切除患者CD4+和CD8+ T淋巴细胞表达CD28抗原的百分比显著低于正常对照组（p < 0.005和p < 0.01）。患者naïve辅助T淋巴细胞百分比明显低于对照组（p < 0.05）。免疫缺陷和复发性感染可能是成人胸腺切除术后免疫功能紊乱的首要症状。建议定期对这些患者进行医学监测，以防止进一步的并发症，这可能导致不可逆的肺组织破坏。
Adult-onset thymoma may be responsible for several diseases, such as pure red cell aplasia, myasthenia gravis, and immunodeficiency (Good’s syndrome). Thymectomy does not always improve the patient’s condition, and may even produce additional symptoms. Its pathogenesis is still not entirely understood, but autoimmunological processes and bone marrow defect are the most frequently suggested. Eleven patients (mean age: 56.2 ± 15.5 years) were analyzed 6 months to 10 years after thymectomy due to thymoma as were 25 healthy persons serving as controls. Enzyme-linked immunosorbent assay (ELISA) and flow cytometry techniques were used to evaluate the immunological status of the subjects. Good’s syndrome was diagnosed in one patient, 4 subjects suffered from myasthenia gravis, and recurrent infections of upper and lower respiratory tract appeared in 9 patients. The immunological analyses (ELISA and flow cytometry) revealed a significantly lower IgG level (p < 0.05), percentage of peripheral blood B lymphocytes (p < 0.0005), and CD4:CD8 ratio (p < 0.05) in thymectomized patients compared with the healthy controls. The percentages of CD4+ and CD8+ T lymphocytes expressing CD28 antigen were significantly lower in thymectomized patients than in healthy subjects (p < 0.005 and p < 0.01, respectively). The percentage of naïve T helper lymphocytes was significantly lower in the patients than in the control group (p < 0.05). Immunodeficiency and recurrent infections may be the first symptoms of immunological disturbances after thymectomy in adults. It is suggested that regular medical monitoring of these patients is important in preventing further complications, which may result in irreversible lung tissue destruction.
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