异基因造血干细胞移植CD34^＋CD61^＋巨核系前体细胞与血小板植入的相关分析  

Correlation between CD34^+CD61^+ Megakaryocyte Precursors and Platelet Engrafment in Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：周立坤[1] 陈惠仁[2] 王恒湘[2] 闫洪敏[2] 段连宁[2] 朱玲[2] 薛梅[2] 刘静[2] 纪树荃[2] 

机构地区：[1]中国医科大学研究生院,沈阳110001 [2]北京空军总医院血液科,北京100036

出　　处：《中国实验血液学杂志》2008年第6期1344-1349,共6页Journal of Experimental Hematology

摘　　要：本研究通过定量测定G-CSF动员后外周血及骨髓采集物的CD34+CD61+细胞,以探索巨核前体细胞CD34+CD61+亚群输注量与异基因外周血和/或骨髓移植后血小板恢复时间的相关性。24例不同血液病患者接受HLA全相合同胞、非血缘供者或单倍体相合同胞造血干细胞移植。20例可评估的患者依移植方法不同分为HLA全相合组和单倍体相合组,HLA全相合组采用PBSC移植方案,单倍体相合组采用PBSC+BM联合移植方案,对外周血干细胞和骨髓样本CD34+CD61+亚群通过流式细胞仪立即测定或隔夜保存后测定。结果表明,单倍体相合组输注CD34+、CD34+CD61+、CD34-CD61+细胞数中位值分别为6.24×106/kg(1.53-20.48)、66.19×104/kg(8.16-493.83)、34.38×106/kg(14.71-109.16);HLA全相合组中位值分别为4.88×106/kg(1.00-8.24)、14.16×104/kg(11.63-96.87)和13.50×106/kg(1.74-35.61)。中性粒细胞计数(ANC)>0.5×109/L和血小板计数>20×109/L的中位时间,单倍体相合组分别为18.5(11.00-29.00)和16.5(9.00-35.00)天;HLA全相合组为14.5(9.00-24.00)和10.5(6.00-37.00)天,血小板的植入时间在两组差别无显著性,中性粒细胞植入时间在HLA全相合组和单倍体相合组差异有显著性(p=0.048),对于两组中CD34+细胞量>2×106/kg的受者血小板的植入时间分析,两组差别有显著性(p=0.006)。CD34+CD61+亚群与血小板植入的相关性明显优越于CD34+细胞,可评估20例(r=-0.449p=0.047CD34+细胞群),单倍体相合组12例CD34+CD61+亚群(r=-0.768p=0.004),HLA相同组8例CD34+CD61+亚群(r=-0.747p=0.033),CD34+CD61+亚群与血小板的植入时间呈负相关关系,输注CD34+CD61+亚群细胞量大,血小板的植入时间缩短。结论:每公斤体重输注CD34+CD61+细胞亚群的量和血小板的植入有显著的相关,通过流式细胞仪测定巨核前体细胞的数目能够预测异基因造血干细胞移植后血小板重建的能力,在单倍体相合外周血和骨髓移植后预测同样有效。This study was purposed to investigate the correlation between the dose infused megakaryocytic precursors （ CD34^＋ , CD34^＋CD61^＋ ） and recovery time of platelet count following an allogeneic PBSCT and/or BMT through quantitative detection of CD34^＋ and its subpopulation in peripheral blood and BM mobilized by G-CSF. 24 patients with various hematologic malignancies recieved PBSCT/BMT from their HLA matched or unrelated donors and haploidentical siblings in April - December 2007. 20 evaluated patients were divided into 2 groups according to different tansplant schemes. HLA matched group received PBSCT regime and haploidentical group recieved PBSCT combined with BMT. CD34^＋ CD61 ^＋ subpopulations in sample from patients recieving PBSCT/BMT were measured by flow cytometry immediately or storage over night. The results showed that the median number of infused CD34 ^＋ , CD34^＋CD61^＋ and CD3^ - CD61^＋ cells in haploidentical group were 6.24 × 10^6/kg （ 1.53 - 20.48 ）, 66.19 × 10^4/kg （ 8.16 - 493.83 ）, and 34.38 × 10^6/kg （ 14.71 - 109.16） respectively, in HLA matched group those were 4.88 × 10^6/kg （ 1.00 - 8.24）, 14. 16 × 10^4/kg （ 11. 63 - 96.87）, and 13.50 × 10^6/kg （ 1.74 - 35.61 ）, respectively. Median days of ANCs 〉 0.5 × 10^9/L and platelets 〉 20 × 10^9/L were 18.5 （ 11.0 - 29.0 ） days and 16.5 （9.0 - 35.0 ） days in haploidentical grouprespectively; in HLA matched group those were 14.5 （9.0 - 24.0） and 10.5 （6.0 -37.0） respectively. A significance difference of median days for ANC engrafment presented between two groups （p = 0. 048 ）. There was no signifciant difference of time for platelet engrafment between 2 groups. For patients with CD34 ^＋ cell dose 〉 2 × 10^6/kg there was singnificant difference of time of platelet engrafment between HLA matched and haploidentical groups （p = 0.006）. The number of CD34^＋ CD61^ ＋ ceils infused in 12 haploidentical patients or in 8 HLA matched patients were much better correlated w

关 键 词：异基因造血干细胞移植 CD34^+CD61^+巨核细胞 HLA全相合 单倍体相合 血小板 

分 类 号：R457.7[医药卫生—治疗学]