造血干细胞移植预处理对血浆ADAMTS-13活性与vWF抗原水平的影响及其临床意义

发布时间：2019-05-03 19:17

【摘要】：目的:通过检测造血干细胞移植(HSCT)患者预处理前后ADAMTS-13活性及v WF抗原含量,探讨预处理过程对ADAMTS-13及v WF水平的影响及评估其临床意义。方法:取113例于苏州大学附属第一医院行造血干细胞移植患者预处理前后外周血,20例健康志愿者外周血(作为对照),采用FRETS-v WF73荧光试验检测血浆ADAM TS-13活性,ELISA法检测v WF抗原量。多数患者采取改良BUCY,部分急性淋巴细胞白血病患者予TBI+CY方案预处理,淋巴瘤患者多用BEAM等方案预处理。结果:①移植后发生血栓并发症8例,49例患者出现急性移植物抗宿主病(a GVHD)。②113例造血干细胞移植患者预处理前后ADAMTS-13活性均较正常对照组低,而v WF抗原含量均高于正常对照组(P0.05)。预处理后ADAM TS-13活性减低的患者占59.3%(69/113),其中活性减低范围在60%以上的患者占8.0%(9/113);相应的VWF抗原含量也出现增高(P0.01)。③8例血栓并发症患者ADAMTS-13活性预处理后均降低,与非血栓组有明显差异(P0.01)。活性减低超过预处理前60%的占37.5%(3/8),同时v WF抗原量增加(P0.01)。④49例a GVHD患者ADAM TS-13活性均值在预处理后降低,但是与非a GVHD患者相比没有明显差异;其中25例患者在a GVHD发生当时ADAMTS-13活性较预处理前发生了明显减低(P0.001),活性减低超过预处理前60%的占6.0%(2/35)。Logistic回归分析表明:移植预处理后ADAM TS-13活性下降超过预处理前60%,是后期发生血栓的风险因素(P0.01);而预处理后ADAM TS-13活性下降不是a GVHD发生的危险因素。结论:造血干细胞移植预处理后ADAMTS-13活性较预处理前下降,v WF抗原含量升高;血栓病人尤为明显。ADAMTS-13活性降幅超过60%是后期发生血栓并发症的危险因素,而预处理后ADAM TS-13活性减低与a GVHD的发生无关。所以ADAM TS-13活性降低是移植后血栓并发症的重要预测指标。
[Abstract]:Aim: to investigate the effect of pretreatment on ADAMTS-13 and v-WF levels and evaluate the clinical significance of ADAMTS-13 activity and v-WF antigen content in patients with hematopoietic stem cell transplantation (HSCT) before and after pretreatment. Methods: peripheral blood samples were collected from 113 patients before and after hematopoietic stem cell transplantation (HSCT) in the first affiliated Hospital of Suzhou University, and 20 healthy volunteers (as control). Plasma ADAM TS-13 activity was measured by FRETS-v WF73 fluorescence test. V WF antigen was detected by ELISA. Most patients with modified BUCY, partial acute lymphoblastic leukemia were pretreated with TBI CY regimen, and patients with lymphoma were pretreated with BEAM and other regimens. Results: 1Thrombosis occurred in 8 cases, acute graft-versus-host disease in 49 cases, acute graft-versus-host disease (a GVHD).) in 2113 cases of hematopoietic stem cell transplantation (HSCT) before and after pretreatment, ADAMTS-13 activity was lower than that in normal control group. The content of v WF antigen was higher than that of normal control group (P0.05). The percentage of patients with decreased ADAM TS-13 activity after pretreatment was 59.3% (69 / 113), of which 8.0% (9 / 113) had a decreased activity range of more than 60%. The content of VWF antigen also increased (P0.01), and the activity of ADAMTS-13 in 38 patients with thrombotic complications decreased after pretreatment, which was significantly different from that in the non-thrombotic group (P0.01). 37.5% (37.5%) decreased activity and increased v WF antigen (P0.01). The mean value of ADAM TS-13 activity decreased after pretreatment in 449 a-GVHD patients. However, there was no significant difference between non-a-GVHD patients and non-a- patients. Among them, 25 patients had a significant decrease in ADAMTS-13 activity at the time of a GVHD (P0.001), compared with pre-treatment (P0.001). Logistic regression analysis showed that the decrease of ADAM TS-13 activity after transplantation was more than 60% before pretreatment, which was the risk factor of thrombosis in late stage (P0.01). The decrease of ADAM TS-13 activity after pretreatment was not a risk factor for the occurrence of a GVHD. Conclusion: the activity of ADAMTS-13 after hematopoietic stem cell transplantation pretreatment is higher than that before pretreatment, and the content of, v WF antigen is higher than that before pretreatment. The decrease of ADAMTS-13 activity by more than 60% was the risk factor of thrombosis complications in late stage, but the decrease of ADAMTS-13 activity after pretreatment was not related to the occurrence of a-GVHD. Therefore, the decrease of ADAM TS-13 activity is an important predictor of thrombus complications after transplantation.
【作者单位】：苏州大学附属第一医院血液科江苏省血液研究所卫生部血栓与止血重点实验室血液学协同创新中心;
【基金】：国家自然科学基金(81270591) 江苏省医学重点人才项目(RC2011105) 江苏省科学自然基金(BK20131167) 江苏省科教兴卫工程-临床医学中心(ZX201102)
【分类号】：R457.7

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