Expression And Correlation Of Shh Protein In Bone Marrow Of Aplastic Anemia

Background and PurposeAplastic Anemia(AA)is a bone marrow hematopoietic failure caused by different causes and mechanisms.The annual incidence rate in China is0.74 per 100,000 people,and the incidence rate is higher in young people and the elderly.AA can be divided into hereditary and acquired type according to the etiology.At present,it is believed that the occurrence and development of primary acquired AA are related to factors such as hematopoietic stem progenitor cell defects,hematopoietic microenvironment abnormalities,and immune abnormalities.The Sonic Hedgehog(SHH)signaling pathway is involved in human embryonic development,and it can regulate the proliferation and differentiation of hematopoietic stem cells,and participate in the body's hematopoietic process by regulating angiogenesis factors,cell cycle,promoting osteoblast differentiation and inhibiting adipocyte differentiation.Is the Shh signaling pathway involved in the pathogenesis of aplastic anemia patients?There are few related studies.The purpose of this study was to investigate the role of Shh in the pathogenesis of AA by detecting the expression of Shh protein in bone marrow tissue of AA patients and analyzing its correlation with the degree of bone marrow hyperplasia,peripheral blood cell counts,lymphocyte subsets,and survival time.Methods1.The clinical data of 33 patients with acquired AA who were hospitalized and confirmed in the Department of Hematology of the First Affiliated Hospital of Guangdong Pharmaceutical University from January 2010 to December 2019 were retrospectively analyzed.Electronic medical records were used to collect the basic information,clinical data,results of auxiliary examinations and laboratory examinations,and follow-up of patients' survival.2.Bone marrow biopsy tissues from 33 AA patients during hospitalization were collected in the pathology department.Shh protein expression in bone marrow tissues was detected by immunohistochemistry.At the same time,bone marrow biopsy tissues from 20 patients with iron deficiency anemia were selected as normal controls.Image Pro Plus 6 software was used to measure and take values to analyze the differences in Shh protein expression between the AA group and the normal control group,the differences of Shh protein in different AA types,gender,age,and different degrees of bone marrow hyperplasia,the correlation of Shh protein expression levels with peripheral blood cell counts,and lymphocyte subsets in AA patients,and analyze the impact of Shh expression levels on survival of AA patients.3.SPSS Stastistics-24 software was used to statistically analyze the data,t test or non-parametric test was used to analyze the difference of Shh protein expression in different groups;linear correlation and linear regression analysis of the correlation between Shh protein and peripheral blood cell count;Kaplan-Meier Perform survival analysis.Results1.The expression of Shh protein in bone marrow of AA patients was significantly lower than that of normal control group(P=0.009).2.There was no significant difference in the expression levels of Shh protein in different types of AA patients(severe/non-severe),degree of hyperplasia(active/low),gender(male/female),and age(>48 years/?48 years)(P>0.05).3.The expression level of Shh protein in patients with AA was positively correlated with white blood cell count(P=0.022),lymphocyte count(P=0.047),and CD4~+/CD8~+cell ratio(P=0.027);There was no significant correlation between the expression of Shh protein and platelet count,red blood cell count,neutrophil count,and reticulocyte count in AA patients(P>0.05).4.There was no significant difference in the percentage of NK cells,B lymphocytes and T lymphocytes between the high expression group of Shh protein and the low expression group(P>0.05).5.There was a difference in survival curves between non-severe AA and patients with severe AA,and the survival rate of non-severe AA is better than severe AA(P=0.007);There were no significant differences in survival between the Shh high expression group and the Shh low expression group,the active myeloproliferative group and the low myeloproliferative group,the normal CD4~+/CD8~+cell ratio group and the abnormal group(P>0.05).Conclusion1.The expression of Shh protein in bone marrow of patients with AA was significantly lower than that in the normal control group.The low expression of Shh protein may be one of the factors involved in the pathogenesis of AA patients.2.The expression of Shh protein in bone marrow of AA patients was positively correlated with white blood cell count,lymphocyte count,and CD4~+/CD8~+ratio.3.Different types were important factors affecting the survival rate of AA patients.