HLA单倍体相合造血干细胞移植后外周血树突细胞重建  

Reconstitution dynamics of plasmacytoid and myeloid dendritic cell precursors after allogeneic HLA mismatched/haploidentical hematopoietic stem cell transplantation

作　　者：吴继颖[1] 黄晓军[1] 

机构地区：[1]北京大学人民医院、北京大学血液病研究所,100044

出　　处：《中华血液学杂志》2007年第2期73-77,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金资助项目（30370591、30470753）;教育部新世纪人才计划（NECT-0443011） 志谢：感谢许兰平、刘代红、韩伟等老师在标本收集方面及刘艳荣、常艳、王卉等老师在流式细胞术测定方面给予的大力协助

摘　　要：目的探讨HLA单倍体相合造血干细胞移植（HSCT）后外周血树突细胞（DC）亚群重建的特点和临床意义。方法选择21例HLA单倍体相合的HSCT患者进行研究，12名健康供者作为对照。流式细胞术检测外周血DC亚群重建及其与急性移植物抗宿主病（aGVHD）的关系。结果白血病患者外周血DC、髓样树突细胞（MDC）和髓样树突细胞1型（MDC1）的百分比分别为0．13％、0．05％和0．03％，绝对值分别为7．89×10^6／L、1．52×10^6／L和1．33×10^6／L；健康对照百分比分别为0．76％、0．65％和0．44％，绝对值分别为42．66×10^6／L、35．56×10^6／L和26．70×10^6／L，白血病患者均明显低于健康对照（P＜0．05）。而白血病患者髓样树突细胞2型（MDC2）、浆样树突细胞（PDC）的百分比分别为0．01％和0．07％，绝对值分别为0．15×10^6／L和2．60×10^6／L；健康对照百分比分别为0．44％和0．14％，绝对值分别为2．40×10^6／L和8．50×10^6／L，两组比较，差异无统计学意义（P＞0．05）；MDC／PDC比值明显减低（P=0．001）。移植后14天（＋14天）MDC1、MDC2及PDC绝对值分别为1．45×10^6／L、0．32×10^6／L和1．60×10^6／L，达到患者移植前水平，但＋100天内均未能恢复正常水平；MDC／PDC比值＋14天（1．40）与移植前（0．50）相比，差异有统计学意义（P=0．024），至＋30天恢复正常（P=0．602）。＋14天高PDC、DC组和低MDC／PDC比值组Ⅱ～Ⅳ度aGVHD的累计发生率较低PDC、DC组和高MDC／PDC比值组明显增高（P＜0．05）。结论白血病患者移植前外周血DC百分比、绝对值及MDC／PDC比值均减少；移植后MDC／PDC比值恢复较快，＋30天恢复正常，其他指标恢复较慢，＋100天内均未恢复正常；且恢复情况与aGVHD相关。Objective To explore the characteristics and significance of reconstitution of peripheral blood dendritic cells（DCs） after HLA haploidentical hematopoietic stem cell transplantation（HSCT）. Methods Twenty-one leukemia patients received HLA-haploidentical HSCT. Twelve healthy donors were as norreal control. Peripheral blood DC subsets were analyzed by flow cytometry, and correlation between DC reconstitution and acute graft versus host disease （aGVHD） were measured. Results Compared with healthy subjects, leukemia patients had a significantly decreased proportion and absolute number of DC, myeloid DC （MDC） and MDC1 （0. 13% vs 0. 76% ,7.89 cells/μl vs 42.66 cells/μl, 0.05% vs 0. 65%, 1.52 cells/μl vs 35.56 cells/μl,0.03% vs 0.44%, 1.33 cells/μl vs 26.70 cells/μl, respectively （ P 〈 0.05 ）. MDC2 and plasmacytoid DC （PDC） were not statistically different between the two groups. The ratio of MDC/PDC was significantly reduced （0.05 vs 4.21 ） （ P = 0. 001 ）. After transplantation, the absolute numbers of MDC1, MDC2 and PDC reached to pretransplant levels at day ＋ 14（ 1.45,0. 32 and 1.60 cells/μl, respectively） （ P 〉 0.05 ）, but remained lower than those of healthy controls up to day ＋ 100. The ratio of MDC/PDC had significantly different between that on ＋ 14 d and pretransplant （1.40 vs 0. 50）（ P = 0. 024 ） and reached to healthy controls levels at day ＋ 30 （2.00 vs 4.21 ）（ P = 0.602）. Patients with higher PDC, DC levels and lower MDC/PDC ratio had lower cumulative incidences of grade Ⅱ - Ⅳ aGVHD as compared with those with lower PDC, DC level and higher MDC/PDC ratio at day ＋ 14 （P = 0. 006, 0.013 and 0. 037, respectively）. Conclusion In HLA haploidentical HSCT recipients, DC reconstitution is a slow process, possibly contributing to the cumulative incidences of grade Ⅱ - Ⅳ aGVHD.

关 键 词：造血干细胞移植 树突细胞 移植物抗宿主病 

分 类 号：R686[医药卫生—骨科学]