供、受体T细胞比例对HLA-半相合异基因造血干细胞移植移植物抗宿主反应的影响  

Influence of T cell ratio between graft T cells and recipient T cells on graft versus host disease in HLA-haploidentical allogenic peripheral blood stem cells transplantation

作　　者：梁辉[1] 翁霞[1] 邓晓辉[1] 

机构地区：[1]上海交通大学医学院附属新华医院血液科,上海200092

出　　处：《临床儿科杂志》2008年第2期116-119,共4页Journal of Clinical Pediatrics

基　　金：上海血液学研究所胡应洲基金科研基金项目资助(2005)

摘　　要：目的研究移植物和受体的T细胞比例与移植物抗宿主反应(GVHD)的关系。方法①实验研究40对小鼠(受体SD小鼠和供体Wistar小鼠)按移植物和受体的T细胞1∶1、2∶1和4∶1比例和对照组分为4组进行移植,并观察移植后GVHD的发生和程度。②临床研究中5例9～18岁患者进行HLA-半相合异体外周血造血干细胞移植,其中4例进行CD34+细胞分选,并计算移植物和受体循环血中T细胞绝对值,按2∶1比例输入;另1例进行常规异体外周血造血干细胞移植。结果实验发现4组小鼠,1∶1和2∶1组的GVHD最轻,与对照组比较差异有统计学意义,而4∶1组的GVHD与对照组比较差异无统计学意义。临床中1例常规方法移植者出现超急性重度GVHD,死于并发间质性肺炎;其余4例仅出现轻度急性GVHD,1例在+155d时死于多发性神经根炎,3例病人移植成功,且均无病生存3年以上。结论移植物内T细胞与受体循环血内的T细胞绝对值之比介于1∶1和2∶1之间较为合适;临床按此比例进行移植,尤其对于HLA部分不相合或半相合的单倍体移植,可获得更好的抗肿瘤效果和较轻的GVHD。Objectives To study the influence of T cell ratio between graft T cells and recipient T cells on graft versus host disease （GVHD）in allogenic peripheral blood stem cells transplantation （PBSCT）. Methods （1）Experiment investigation： 40 SD rats were transplanted with 40 Wistar rats in allo-BMT model. Recipient rats were divided into 4 groups according to the T cell ratio（graft： recipient）, that were 1：1, 2：1, 4：1 and control group, and the occurrence and degree of GVHD after allo-PBSCT were observed. （2）Clinical research： 5 cases HLA-haploidentical allogenic PBSCT. Four patients were treated with the allo-CD34^＋ cells purification transplantation by calculating the T cells absolute value of graft and recipient according to the ratio 2：1. Another 1 patient were treated with classical Allo-PBSCT method. Results Clinical research： an ultra-acute severe GVHD occurred to a patients who was transplanted with classic method. He was died of secondary interstitial pneumonia. The other 4 cases only presented light GVHD. With the exception of 1 patient died of polyradiculitis on day ＋155, 3 other patients all had disease free survival more than 3 years. Experiment research： 4 groups of rats, the occurrence of GVHD in group 1：1 and in group 2：1 were the least. There was a significant difference between these two groups and the control group. However there was no significant difference between the group 4：1 and the control group. Conclusions The most appropriate T cell ratio between graft and recipient would be 1：1 or 2：1. If clinical transplantation were applied with such ratio, especially to part HLA-unrelated and HLA-haploidentical transplantation, a better anti-tumor effect and a lighter GVHD presentation would be achieved.

关 键 词：造血干细胞移植 供-受体T细胞比例 HLA-半相合 移植物抗宿主反应 小鼠 儿童 

分 类 号：R457.7[医药卫生—治疗学] Q95-3[医药卫生—临床医学]