异基因造血干细胞移植后淋巴细胞亚群重建及相关因素分析研究
发布时间：2019-01-22 16:04
【摘要】：目的:探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后1年内患者体内淋巴细胞亚群变化并分析移植患者年龄、HLA相合情况、移植物抗宿主病、感染并发症等对淋巴细胞亚群变化的影响。方法:回顾性分析36例2013年3月至2016年4月在重庆医科大学附属第二医院行allo-HSCT患者,用流式细胞仪检测患者外周血在移植前、移植后1月、3月、6月、12月时的淋巴细胞亚群绝对计数值,观察各淋巴细胞免疫表型包括CD3+、CD4+、CD8+、CD19+、CD16+CD56+(NK细胞)、CD4+CD25+Fox P3+(调节T细胞,Treg细胞)移植后变化情况,分析患者年龄、HLA相合情况、移植物抗宿主病、感染并发症等对移植前后淋巴细胞亚群变化的影响。结果:CD3+T淋巴细胞移植后1月明显下降,第3月逐渐恢复,第6月接近移植前水平;CD4+T淋巴细胞亚群移植后第1月明显下降,第3月以后逐渐恢复,第12月仍未恢复到移植前水平;CD8+T淋巴细胞亚群移植后1个月下降幅度小于CD4+T淋巴细胞亚群,移植3月后CD8+T淋巴细胞数明显恢复并超过移植前水平,12月明显高于移植前水平;CD4+/CD8+比值在移植后一直呈倒置状态;CD19+B淋巴细胞在移植后1个月明显低下降,第3月开始缓慢恢复,至6月仍明显低于移植前水平,至移植后12个月基本恢复至移植前水平。NK细胞在移植后1月无明显变化,移植后3月逐渐上升并超过移植前水平,第12月明显超过移植前水平。调节性T淋巴细胞在移植后1月轻微下降,后缓慢上升,到6月达移植前水平。移植后年龄大于等于40岁及小于40岁组、感染和非感染组各淋巴细胞亚群计数无统计学差异,HLA全相合移植淋巴细胞亚群计数恢复快于单倍体移植组,发生II-IV度a GVHD患者组CD3+T淋巴细胞、CD4+T淋巴细胞亚群、CD19+B淋巴细胞、NK细胞计数均低于0-I度a GVHD患者组。结论:异基因造血干细胞移植受者体内各淋巴细胞亚群计数恢复都有一定的规律,患者年龄、移植后感染并发症不影响免疫重建,a GVHD可能延缓早期淋巴细胞的恢复,HLA全相合移植相比单倍体移植更有利于淋巴细胞亚群的恢复。
[Abstract]:Objective: to investigate the changes of lymphocyte subsets in patients with allogeneic hematopoietic stem cell transplantation (allogeneic hematopoietic stem cell transplantation,allo-HSCT) within one year, and to analyze the age, HLA compatibility and graft versus host disease (GVHD) in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Effects of infection complications on lymphocyte subsets. Methods: a retrospective analysis of 36 patients with allo-HSCT in the second affiliated Hospital of Chongqing Medical University from March 2013 to April 2016 was performed. The peripheral blood was detected by flow cytometry before, 1 month, 3 months and 6 months after transplantation. The absolute count of lymphocyte subsets was measured at 12 months. The changes of lymphocyte immunophenotypes including CD3, CD4, CD8, CD19, CD16 CD56 (NK cells), CD4 CD25 Fox P3 (regulating T cells, Treg cells) were observed, and the age of the patients was analyzed. The effects of graft versus host disease (GVHD) and infection complications on lymphocyte subsets before and after transplantation were observed. Results: CD3 T lymphocytes decreased significantly in 1 month, recovered gradually in the third month, and approached the pre-transplant level in the sixth month. CD4 T lymphocyte subsets decreased significantly in the first month after transplantation, gradually recovered after the third month, and did not return to the pre-transplant level in the 12th month. The decrease of CD8 T lymphocyte subsets was less than that of CD4 T lymphocyte subsets 1 month after transplantation. The number of CD8 T lymphocytes recovered significantly after 3 months of transplantation and exceeded the pre-transplant level, and in 12 months it was significantly higher than that before transplantation. The ratio of CD4 / CD8 was inverted after transplantation. CD19 B lymphocytes decreased significantly at 1 month after transplantation, then recovered slowly in the third month, and were still significantly lower than those before transplantation in June, and basically recovered to pre-transplant level 12 months after transplantation. NK cells did not change significantly at one month after transplantation. The level of pretransplant increased gradually in 3 months after transplantation and exceeded the level before transplantation in the 12th month. Regulatory T lymphocytes decreased slightly in one month after transplantation, then increased slowly, and reached pre-transplant level in June. There was no significant difference in lymphocyte subsets between infected group and non-infected group after transplantation. The subsets of lymphocyte subsets of HLA homozygous transplantation recovered faster than those of haploid transplantation group. The counts of CD3 T lymphocytes, CD4 T lymphocyte subsets, CD19 B lymphocytes and NK cells in patients with II-IV degree a GVHD were lower than those in patients with 0-I degree a GVHD. Conclusion: the recovery of lymphocyte subsets in allogeneic hematopoietic stem cell transplantation recipients has a certain regularity. The age of the patients and the infection complications after transplantation may delay the recovery of lymphocytes in the early stage. HLA homozygous transplantation was more beneficial to the recovery of lymphocyte subsets than haploid transplantation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R457.7
[Abstract]:Objective: to investigate the changes of lymphocyte subsets in patients with allogeneic hematopoietic stem cell transplantation (allogeneic hematopoietic stem cell transplantation,allo-HSCT) within one year, and to analyze the age, HLA compatibility and graft versus host disease (GVHD) in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Effects of infection complications on lymphocyte subsets. Methods: a retrospective analysis of 36 patients with allo-HSCT in the second affiliated Hospital of Chongqing Medical University from March 2013 to April 2016 was performed. The peripheral blood was detected by flow cytometry before, 1 month, 3 months and 6 months after transplantation. The absolute count of lymphocyte subsets was measured at 12 months. The changes of lymphocyte immunophenotypes including CD3, CD4, CD8, CD19, CD16 CD56 (NK cells), CD4 CD25 Fox P3 (regulating T cells, Treg cells) were observed, and the age of the patients was analyzed. The effects of graft versus host disease (GVHD) and infection complications on lymphocyte subsets before and after transplantation were observed. Results: CD3 T lymphocytes decreased significantly in 1 month, recovered gradually in the third month, and approached the pre-transplant level in the sixth month. CD4 T lymphocyte subsets decreased significantly in the first month after transplantation, gradually recovered after the third month, and did not return to the pre-transplant level in the 12th month. The decrease of CD8 T lymphocyte subsets was less than that of CD4 T lymphocyte subsets 1 month after transplantation. The number of CD8 T lymphocytes recovered significantly after 3 months of transplantation and exceeded the pre-transplant level, and in 12 months it was significantly higher than that before transplantation. The ratio of CD4 / CD8 was inverted after transplantation. CD19 B lymphocytes decreased significantly at 1 month after transplantation, then recovered slowly in the third month, and were still significantly lower than those before transplantation in June, and basically recovered to pre-transplant level 12 months after transplantation. NK cells did not change significantly at one month after transplantation. The level of pretransplant increased gradually in 3 months after transplantation and exceeded the level before transplantation in the 12th month. Regulatory T lymphocytes decreased slightly in one month after transplantation, then increased slowly, and reached pre-transplant level in June. There was no significant difference in lymphocyte subsets between infected group and non-infected group after transplantation. The subsets of lymphocyte subsets of HLA homozygous transplantation recovered faster than those of haploid transplantation group. The counts of CD3 T lymphocytes, CD4 T lymphocyte subsets, CD19 B lymphocytes and NK cells in patients with II-IV degree a GVHD were lower than those in patients with 0-I degree a GVHD. Conclusion: the recovery of lymphocyte subsets in allogeneic hematopoietic stem cell transplantation recipients has a certain regularity. The age of the patients and the infection complications after transplantation may delay the recovery of lymphocytes in the early stage. HLA homozygous transplantation was more beneficial to the recovery of lymphocyte subsets than haploid transplantation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R457.7
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