Objective To detect the expression of CD55 and CD59 on red blood cells and granu-locytes in peripheral blood of patients with chronic aplastic anemia (CAA) , and to explore its relationship to the efficacy and prognosis of cyclosporine A (CsA) treatment. Methods The expression of CD55 and CD59 was detected in 67 CAA patients and 30 normal subjects using fluo-rescein-labeled anti-CD55 and anti-CD59 monoclonal antibodies by flow cytometry. These patients were divided into group A and group B according to whether patients had paroxysmal nocturnal hemoglobinuria (PNH)-type CD55- CD59- peripheral erythrocytes and/or neutrophils. All patients were treated with CsA for more than 6 months and were followed up. Results The percentage of PNH-type cells was less than 3. 0% and 3. 0% to 10. 0% in all normal subjects and 57 CAA patients, respectively. The median follow-up time was 28. 2 months (range 17. 0-51. 4 months). The onset time of CsA effect,effective rate,recurrence rate,3-year overall survival rate and 1-year disease-free survival rate were, respectively, (5. 18±2. 53) months, 87. 7%(50/57), 10.0% (5/50), 100. 0% and 43.9% (25/57) in group A,and (10.67 + 1. 15)months,30. 0% (3/rn10) ,66. 7% (2/3) ,44. 4% and 10. 0%(l/10) in group B. The differences were significant between the two groups (P<0. 001 or P<0. 05). Conclusion The PNH-type erythrocytes and/or neutro-phils are present in patients with CAA at low levels. Compared with patients without PNH-type cells,CsA treatment sensitivity,effective rate,3-year overall survival rate and 1-year disease-free survival rate increase and recurrence rate decreases in patients with PNH-type cells. These results will contribute to medication guidance and prognosis prediction in patients with CAA.%目的 检测慢性再生障碍性贫血(CAA)患者外周血中红细胞和粒细胞膜CD55、CD59表达情况,探讨其与环孢素A(CsA)疗效和预后的关系.方法 采用荧光素标记CD55和CD59单克隆抗体,流氏细胞术检测30例正常人和67例CAA患者.根据CAA外周血红细胞和(或)中性粒细胞是否含有PNH样的CD55-、CD59-细胞分为A组和B组.均予CsA为主治疗大于6个月,并随访观察.结果 正常人PNH样的细胞均＜3.0％,CAA患者85.1％(57例)为3.0％～10.0％之间,A组与B组比较:对CsA为主的治疗起效时间早,分别为(5.18±2.53)个月与(10.67±1.15)个月,P＜0.001；有效率高,分别为87.7％(50/57)、30.0％ (3/10),P＜0.001；中位随访时间是28.2个月(17.0～51.4个月),复发率低,分别为10.0％(5/50)、66.7％(2/3),P＜0.05；3年总生存率高,分别为100.0％、44.4％,P＜0.001；1年无病生存率高,分别为43.9％ (25/57)、10.0％(1/10),P＜0.05.结论 CAA患者红细胞和(或)中性粒细胞存在微量PNH样细胞,有PNH样细胞的CAA对CsA为主治疗敏感起效快,有效率高,复发率低,3年累积总生存率及1年累积无病生存率均高,有助指导临床用药及预测预后.
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