| Objective: By observing the changes of Natural Killer Cells' surface active receptor,NKG2 D and its serum soluble ligand sNKG2DL(such as sMICA,sMICB,sULBP1 and sULBP2)in different groups of elderly acute myeloid leukemia patients after a demethylation treatment cycle with Chinese Tradiontinal Medicine,we would like to konw how it influences immunity.In addition,we want to figure out the mechanism of NKG2D-mediated immune surveillance and immune evasion in acute myeloid leukemia.Method: From March 2018 to January 2019,60 people were selected as subjects from the department of hematology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine.According to the random table and the entry order,they were divided into four groups(4 cases fell off during the test).The first group(15 people)was given a conservative treatment and the second group(15 people)was given an oral therapy of TCM on the basis of the first group treatment.The third group(12 people)was given a demethylation treatment and the fourth group(14 people)was given an oral therapy of TCM on the basis of the first group treatment.The course of treatment was one month,and the serum contents of NKG2 D and sNKG2 DL from 4 groups were respectively detected by ELISA on d0,d7,d14,d21 and d28.Afterwards,the experimental data were analyzed by SPSS 22.0 and the difference was statistically significant at P < 0.05.Result:1.NKG2D In the first 2 weeks after the demethylation,the level of NKG2 D in the fourth group decreases,while the third group increases at first and then decreases,but there is no statistical significance,and then it shows a gradual upward trend.After the intervention of TCM,the level of NKG2 D in the fourth group is significantly higher than the third group(P=0.03<0.05)and the first group(P=0.022<0.05).In addition,the control group shows no significant changes and differences throughout the treatment.2.sMICA In the first week after the demethylation,the level of sMICA in the third groupdecreases significantly(P=0.00<0.05),while in the intervention of TCM,the decrease of the fourth group is not obvious(P=0.094>0.05),followed by the upward trend.At the end of treatment,the level of sMICA in the third group is significantly higher than the fourth group(P=0.046<0.05)and the second group(P=0.001<0.05).In addition,there are no significant changes and differences in the control group throughout the treatment.3.sMICB In the first week after the demethylation,the level of sMICB in the third group and the fourth group decreases significantly(P=0.00<0.05 and P=0.022<0.05),and then increased.At the end of treatment,the third group is significantly higher than the fourth group(P=0.049<0.05)and the second group(P=0.004<0.05).In addition,the level of sMICB in the first group shows a gradual upward trend throughout the treatment,but there are no significant changes and differences in the second group.4.sULBP1 In the first week after the demethylation,the level of sULBP1 in the third group decreases significantly(P=0.00<0.05)while in the intervention of TCM,the fourth group doesn't decrease significantly(P=0.926>0.05).In the ascending trend,the level of sULBP1 in the third group is significantly higher than the second group at the end of treatment(P=0.036<0.05).In addition,there are no significant changes and differences in the control group throughout the treatment.5.sULBP2 In the first 2 weeks after the demethylation,the level of sULBP2 in the third group and the fourth group decreases significantly(P=0.00<0.05 and P=0.006<0.05),then both increases.At the end of treatment,the third group is significantly higher than the fourth group(P=0.033<0.05)and the second group(P=0.027<0.05).In addition,there are no significant changes and differences in the control group throughout the treatment.6.Blood Routine Examination In the first week after the treatment,WBC,HGB and ANC of the experimental group are significantly inhibited by the demethylation,but the decline trend of the fourth group is slower than third group.As time passed,it is gradually increasing.Among them,the increase of WBC in the third group is significantly higher than that in the fourth group(P=0.031<0.05),and there is no significant difference.There are no significant changes and differences in PLT of the experimental group throughout thetreatment.In addition,there are no significant changes and differences in WBC,ANC and PLT in the control group throughout the treatment.7.Evaluation Form With the progress of the treatment,the scores of syndrome points in the second group and the fourth group are decreasing significantly with the intervention of TCM.In the3 rd and 4th week of treatment,the first group is significantly higher than the second group and the fourth group;the third group is significantly higher than the fourth group.8.The Correlation of Age between Immunity Except for the first week of treatment which shows no significant correlation between age and NKG2 D and sNKG2 DL,there is a significant correlation between age and immunity.Obviously,age has a significant negative correlation with NKG2 D suggesting that a person is getting older,his or her NKG2 D is decreasing.On the other hand,age has a significant positive correlation with sNKG2 DLwhich means that a person is getting older,his or her sNKG2 DL is inecreasing.But the correlation coefficient is not strong and the increasing trend is slow.Conclusion:1.After demethylation,tumor immune evasion may be inhibited while NK cell immune surveillance may be damaged.Under the intervention of TCM,the recovery of immunity is significantly higher than the control group,which proves that TCM may improve immune surveillance to some extent.Furthermore,sNKG2 DL is gradually coming back to its initial level,which indicates the recurrence of tumor.2.After demethylation,myelosuppression happens,but TCM can reduce its occurrence.3.Compared with simple western medicine,TCM can significantly improve the the symptoms of elderly AML patients.4.With the increase of age,NK cell immune surveillance is declining while the tumor immune evasion may is rising. |
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