移植物中不同种类和数量的细胞对异基因外周血造血干细胞移植后急性GVHD的影响  

The impact of cell doses in graft on acute graft-versus-host disease following HLA-identical sibling allogeneic peripheral blood hematopoietic stem cell transplantation

作　　者：周征[1] 王玫[1] 何祎[1] 翟文静[1] 王华[1] 张荣莉[1] 翟卫华[1] 包宇实[1] 冯四洲[1] 韩明哲[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血液病医院,天津300020

出　　处：《中华器官移植杂志》2009年第4期231-235,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨移植物中单个核细胞（MNC），CD34^＋细胞，T淋巴细胞（包括CD3^＋、CD3^＋CIN^＋、CD3^＋CD8^＋和CD4^＋CD25^＋），CD3CD16^＋CD56^＋自然杀伤（NK）细胞，以及树突状细胞（DC）Ⅰ和Ⅱ型（DC1和DC2）的数量对人类白细胞抗原（HLA）相合的同胞异基因外周血造血干细胞移植（allo—PBsCT）后急性移植物抗宿主病（aGVHD）的影响。方法选择65例接受HLA相合的同胞allo-PBSCT的患者进入研究。采用流式细胞术检测移植物中MNC，CD34^＋细胞，T淋巴细胞（CD3^＋、CD3^＋CIN^＋及CD3^＋CD8^＋）的数量，对其中31例患者进一步检测CD4^＋CD25^＋T淋巴细胞、CD3^＋CD16^＋CD56^＋NK细胞及DC的数量。按患者的每公斤体重计算出输注的移植物中以上各细胞的数量，并根据上述细胞数量的中位数分别将患者分为高数量组（〉中位数）和低数量组（≤中位数），比较各高数量和低数量组aGVHD的发生情况。结果CD3^＋CD4^＋、CD3^＋CD8^＋T淋巴细胞高数量组和相应低数量组相比，Ⅱ～Ⅳ度aGVHD的累积发生率增加，但差异无统计学意义（P值分别为0．089和0．098）；CD4^＋CD25^＋T淋巴细胞高数量组Ⅲ～Ⅳ度aGVHD的累积发生率显著低于相应低数量组（P〈0．05）；DC1高数量组总的aGVHD累积发生率显著高于相应低数量组（P〈0．05），Ⅱ～Ⅳ度aGVHD累积发生率亦明显高于相应低数量组，但差异无统计学意义（P=0．069）。MNC、CD34^＋细胞、CD3^＋T淋巴细胞、CD3CD16^＋CD56^＋NK细胞及DC2高数量组与相应低数量组比较，总的及Ⅱ～Ⅳ度aGVHD的累积发生率差异均无统计学意义（P〉0．05）。结论移植物中高数量的DCl增加总的aGVHD的累积发生率；而高数量的CD4^＋CD25^＋T淋巴细胞则减少Ⅲ～Ⅳ度aGVHD的累积发生率。Objective To explore the influence of mononuclear cells （MNC）, CD34^＋ cells, CD3^＋ , CD3^＋ CD4^＋ , CD3^＋ CD8^＋ , CD4^＋ CD25^＋ T cells, CD3 CD16^＋ CD56^＋ natural killer cells （NKs）, and dendritic cells （DCs） doses in graft on acute graft-versus-host disease （aGVHD） following HLA-identical sibling allogeneic peripheral blood hematopoietic stem cell transplantation （allo-PBSCT）. Methods Sixty-five patients receiving HLAqdentical sibling allo-PBSCT were studied. The number of CD34^＋ , CD3^＋ , CD3^＋ CD4^＋ , and CD3^＋ CD8^＋ T cells in the graft was counted by fluorescence-activated cell sorting （FACS）. The number of CD4^＋ CD25^＋ T cells, CD3 CD16^＋ CD56^＋ NKs, and DCs in the graft was also measured by FACS in 31 patients among above-mentioned 65 patients. The doses of each kind of cells in the graft were calculated according to per kilogram of recipients body weight. The patients were divided into high or low dose groups according to whether or not more than or equal to median of MNC, CD34＋ , CD3＋ , CD3＋ CD4＋ , CD3＋ CD8^＋ , CD4＋ CD25^＋ , CD3 CDI6^＋ CD56^＋ or DC cell doses, respectively. Acute GVHD was analyzed between two groups. Results The frequency of the cumulative incidence of grade II^＋ IV aGVHD was increased in CD3^＋ CI3^＋＋ and CD3^＋ CD8＋ T cells high dose groups as compared with correspondingly low dose groups, but the difference had no statistically significant difference （P = 0. 089 and 0. 098, respectively）. Recipients in CD4^＋ CD25^＋ T cells high dose group had significantly reduced cumulative incidence of grade Ⅲ-Ⅳ aGVHD as compared with those in correspondingly low dose group （P〈 0. 05）. The cumulative incidence of total aGVHD was significantly higher in CD1 high dose group than in correspondingly low dose group （P〈0. 05） and the cumulative incidence of grade Ⅱ-Ⅳ aGVHD was also higher in high dose group, but the difference had no statistically significant difference （P = 0. 069）.

关 键 词：造血干细胞移植 移植物抗宿主病 T淋巴细胞 杀伤细胞 天然 树突细胞 

分 类 号：R686[医药卫生—骨科学]