造血干细胞移植后的早期免疫重建

发布时间：2018-04-18 02:08

本文选题：造血干细胞移植 + 自体移植　；参考：《北京大学学报(医学版)》2016年03期

【摘要】：目的:探讨异基因造血干细胞移植(allogenic hematopoietic stem cell transplantation,allo-HSCT)和自体造血干细胞移植(autologous HSCT,auto-HSCT)患者早期免疫重建的异同。方法:收集2011年12月至2014年8月在北京大学第三医院血液科进行HSCT的恶性血液病患者31例,其中15例allo-HSCT,16例auto-HSCT;留取20名健康人外周血标本作为健康对照。采用四色流式细胞术检测两组患者移植后1年内外周血中淋巴细胞亚群的动态变化,并通过检测T细胞受体重排删除环(T cell receptor rearrangement excision circle,TREC)水平判断初始T细胞功能。结果:移植后12个月内allo-HSCT组和auto-HSCT组患者CD4+T细胞、CD8初始T细胞、效应记忆性T细胞、CD4中枢记忆性T细胞、中期活化性T细胞以及DC重建与健康对照组比较差异有统计学意义(P0.05),但两组患者间差异无统计学意义(P0.05),CD8+T细胞和NK细胞迅速恢复正常水平。移植后前3个月内B细胞重建在两组患者间差异无统计学意义(P0.05),均显著低于健康对照组(P0.01),但从第6个月起auto-HSCT组显著快于allo-HSCT组患者(P0.05);移植后第6个月起allo-HSCT组晚期活化性T细胞表达显著高于auto-HSCT组(P0.05),而auto-HSCT组CD4初始T细胞和CD8中枢记忆性T细胞的表达高于allo-HSCT组(P0.05)。移植后12个月内allo-HSCT和auto-HSCT组患者外周血CD3+T细胞中TREC水平显著低于年龄相近的健康对照组(P0.05),allo-HSCT组患者外周血CD3+T细胞中的TREC水平稍高于auto-HSCT组患者,但差异无统计学意义(P0.05)。结论:allo-HSCT和auto-HSCT患者早期免疫重建的速度和特点很相似,移植患者免疫重建主要不是由异源性移植物所决定,可能与胸腺功能受损后T细胞分化缓慢密切相关。
[Abstract]:Objective: to investigate the differences and similarities of early immune reconstitution between allogenic hematopoietic stem cell transplantationallo-HSCT and autologous HSCTauto-HSCT in patients with allogenic hematopoietic stem cell transplantation (HSCT) and autologous hematopoietic stem cell transplantation (HSCT).Methods: from December 2011 to August 2014, 31 patients with malignant hematological diseases, including 15 patients with allo-HSCT and 16 patients with auto-HSCT, were collected from hematology department of the third Hospital of Peking University.Four color flow cytometry (FCM) was used to detect the dynamic changes of lymphocyte subsets in peripheral blood of the two groups within one year after transplantation, and to determine the initial T cell function by detecting the T cell receptor rearrangement excision circle level of T cell receptor rearrangement.Results: within 12 months after transplantation, the CD4 T cells in allo-HSCT group and auto-HSCT group had the initial CD8 T cells, and the effector memory T cells were CD4 central memory T cells.The difference of activated T cells and DC reconstruction between the two groups was statistically significant (P 0.05), but there was no significant difference between the two groups in the level of CD8 T cells and NK cells.In the first 3 months after transplantation, there was no significant difference between the two groups in B cell reconstruction, both of which were significantly lower than that of the healthy control group (P 0.01), but from the 6th month the auto-HSCT group was significantly faster than that of the allo-HSCT group, and the late stage of the allo-HSCT group was alive from the 6th month after transplantation.The expression of chemotypic T cells was significantly higher than that of auto-HSCT group (P 0.05), while the expression of CD4 initial T cells and CD8 central memory T cells in auto-HSCT group was higher than that in allo-HSCT group.Within 12 months after transplantation, the level of TREC in peripheral blood CD3 T cells in allo-HSCT and auto-HSCT group was significantly lower than that in control group (P 0.05). The level of TREC in peripheral blood CD3 T cells in allo-HSCT and auto-HSCT group was slightly higher than that in auto-HSCT group, but the difference was not statistically significant (P 0.05).Conclusion the rate and characteristics of early immune reconstruction in patients with auto-HSCT and W / allo-HSCT are similar. The immune reconstruction in transplant patients is not mainly determined by allografts and may be closely related to the slow differentiation of T cells after thymic dysfunction.
【作者单位】：北京大学第三医院血液科;
【分类号】：R457.7

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