儿童急性淋巴细胞白血病化疗后免疫系统重建的研究  

Immune system reconstitution in children with acute lymphoblastic leukemia after cessation of chemotherapy

作　　者：张瑞东[1] 刘怡[1] 张永红[1] 石慧文[1] 谢静[1] 胡亚美[1] 吴敏媛[1] 

机构地区：[1]首都医科大学附属北京儿童医院血液病中心,北京100045

出　　处：《临床儿科杂志》2008年第8期669-673,共5页Journal of Clinical Pediatrics

摘　　要：目的观察急性淋巴细胞白血病(ALL)儿童在化疗结束后淋巴细胞亚群和免疫球蛋白的变化,了解化疗后免疫系统的恢复过程。方法采用流式细胞仪分析76例ALL治疗后停药患儿的外周血淋巴细胞亚群,应用单向琼脂扩散法测定其中64例患儿血清IgA、IgG、IgM的浓度。结果CD3^+HLA^-DR^+细胞、CD4^+CD45RO^-CD45RA^-细胞百分率在停药后0～12个月组高于对照组(P<0.05),CD3^+CD4^-CD8^+、CD8^+CD28^-细胞百分率在停药后0～12个月、12～24个月、24～48个月组均高于对照组,CD3^+CD8^-CD4^+、CD4^+CD29^-、CD4^+CD45RO^-CD45RA^+细胞的百分率、CD4/CD8比值、CD45RA/CD45RO比值在停药各个阶段与对照组相比明显降低(P<0.05)。CD19^+CD5^+细胞的百分率在停药后0～12个月、12～24个月组高于对照组,IgG浓度停药0～12个月低于参考值(P<0.05)。结论化疗结束后,患儿的免疫系统恢复需要较长的时间。NK细胞在停药时即正常。B细胞在停药2年后已经基本恢复,T淋巴细胞的恢复最慢。Objectives Recovery of peripheral blood lymphocyte （PBL） subsets and serum immunoglobulins A, G, M （IgA, IgG, IgM） after cessation of chemotherapy were examined to clarify the reconstitution of the immune system in children with acute lymphoblastic leukemia （ALL）. Methods PBL subsets of 76 children with ALL after cessation of chemotherapy were analyzed by flow cytometry and serum immunoglobulins were assayed by the single radial diffusion method. Results The percence of CD3＋HLA-DR＋. CD4＋CD45RO-CD45RA- cells were significantly higher than those of the control group during the first 0 - 12 months after cessation of chemotherapy （P 〈 0.05）. The percence of CD3＋CD4-CD8＋, CD8＋CD28- cells were higher in 0 - 12 months, 12 - 24 months, 24 - 48 months after cessation of chemotherapy than those of the control group （P 〈 0.05）. The percentage of CD3＋CD4＋CD8-, CD4＋CD29-, CD4＋ CD45RO-CD45RA＋, and CD4/CD8, CD45RA/CD45RO cells were all significantly lower than those of the control group during observation （P 〈 0.05）. The percentage of CD19＋CD5＋ cells was higher than that of the control group at 0 - 12 months and 12 - 24 months after cessation of chemotherapy. Serum IgG concentration was lower in the 0 - 12 months after cessation of chemotherapy group than that of control group （P 〈 0.05）. Conclusions It requires long time to get recovery of immune system in children with ALL after chemotherapy. The percentage of NK cell recovered as soon as chemotherapy stopped, while the B cell recovered two years after the chemotherapy cessation and the recovery of T cell takes even longer.

关 键 词：急性淋巴细胞白血病 免疫系统 化疗 外周血淋巴细胞 

分 类 号：R733.71[医药卫生—肿瘤]