严重型再生障碍性贫血患者骨髓造血祖细胞集落形成与免疫抑制治疗疗效的关系  

Colony formation of bone marrow hematopoietic progenitor cells in patients with severe aplastic anemia and its relation to the results of immunosuppressive therapy

作　　者：夏长青[1] 储榆林[1] 邵宗鸿[1] 郑以州[1] 汤晓培[1] 田征[1] 陈桂彬[1] 张益枝[1] 张君奎[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所

出　　处：《中华血液学杂志》1997年第10期538-540,共3页Chinese Journal of Hematology

摘　　要：目的：进一步阐明严重型再生障碍性贫血（ＳＡＡ）患者骨髓造血干细胞缺陷的实质；初步分析ＳＡＡ患者骨髓造血祖细胞集落的形成与免疫抑制治疗（ＩＳＴ）疗效的关系。方法：采用造血祖细胞甲基纤维素半固体培养法。结果：研究的３０例初诊ＳＡＡ患者中，９０％的患者ＣＦＵ－Ｅ，ＢＦＵ－Ｅ，ＣＦＵ－ＧＭ的形成明显减少，５６．７％的患者治疗前无任何集落形成，然而，有１０％的患者，其ＣＦＵ－Ｅ，ＢＦＵ－Ｅ和ＣＦＵ－ＧＭ中的１种或２种集落正常或接近正常；ＩＳＴ可使５９．１％的患者出现一系以上的集落形成或集落形成的增加，治疗前后比较，具有显著性差异（ＣＦＵ－Ｅ和ＢＦＵ－ＥＰ＜０．０１，ＣＦＵ－ＧＭＰ＜０．０５），但多数患者集落的形成达不到正常水平，并有２２．７％的患者无集落形成；治疗前有集落形成患者的ＩＳＴ有效率为８０％，而无集落形成者为５０％，但差异不明显（Ｐ＞０．０５）；ＳＡＡ患者骨髓造血祖细胞集落形成的增加往往落后于ＩＳＴ疗效的出现，而骨髓象巨核细胞的出现常伴有造血祖细胞集落形成的明显增加。结论：多数ＳＡＡ存在造血干、祖细胞的缺陷且可能是由免疫损伤机制引起；ＩＳＴ可改善ＳＡＡ患者的体内、外造血；ＩＳＴ前后检测骨髓造血祖细胞集落的形?Objective:To explore the defect of hematopoietic stem cell and analyze the relationship between the colony formation capacity of bone marrow hematopoietic progenitor cells and the results of immunosuppressive therapy (IST) in severe aplastic anemia (SAA) patients. Methods: Methylcellulose semisolid culture was used. Results: Thirty patients with SAA at diagnosis were studied. In 90% of the patients, the CFU E and CFU GM yields were strikingly decreased and in 56.7% of the patients there was no colony formation at all. Nevertheless, there was still 10% of the patients having normal CFU E,BFU E or/ and CFU GM yields. After IST, 59.1% of the patients showed colony formation improvement. The difference between the results obtained pre and post IST(for CFU E and BFU E, P<0.01, for CFU GM, P<0.05) was significant. In the majority of the patients, the colony formation capacities were still under the normal post IST. Moreover, 22.7% of the patients remained no colony formation post IST. The IST response rates between the patients with or without colony formation had no statistically difference (80% versus 50%, P<0.05). The increment of colony formation appeared later than the therapeutic effectdid, but frequently concurred with the appearance of magkaryocytes in the bone marrow smear. Conclusion: In the majority of SAA patients, the hematopoietic stem cells or progenitors were defective perhaps caused by immune damage; IST can improve the hematopoiesis in vitro and in vivo of SAA patients.

关 键 词：再生障碍性贫血 骨髓 造血干细胞 免疫抑制疗法 

分 类 号：R556.505[医药卫生—血液循环系统疾病]