异基因造血干细胞移植早期TNF-α、IL-1β、IFN-γ改变的临床意义  

Clinical Significance of TNF-α,IL-1β and IFN-γ Levels at Early Phase after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：高海丽[1] 孙爱宁[1] 韩悦[1] 张威[1] 胡晓慧[1] 吴德沛[1] 阮长耿[1] 

机构地区：[1]苏州大学附属第一医院血液科江苏省血液研究所,江苏苏州215006

出　　处：《中国实验血液学杂志》2009年第5期1321-1325,共5页Journal of Experimental Hematology

基　　金：江苏省社会发展基金(编号BS2005024);江苏省自然科学基金(编号BK2007508);江苏省卫生厅医学重点人才项目(编号RC2007073)

摘　　要：本研究探讨异基因造血干细胞移植患者早期TNF-α、IL-1β、IFN-γ的变化规律,分析其在预处理过程中的改变情况及其与移植相关并发症之间的关系。采用酶联免疫吸附法(ELISA)检测95例异基因造血干细胞移植患者(其中aGVHD组43例,血栓组5例,感染组31例)预处理前后以及移植后各周内血清TNF-α、IL-1β、IFN-γ水平的动态变化,以20例健康成人作为正常对照,观察预处理前后细胞因子的改变,探讨细胞因子和各并发症之间的关系。结果表明:预处理前TNF-α水平在aGVHD组已较正常升高(p(0.01),在其他患者中未见明显改变。在预处理第4天后所有患者TNF-α水平都较预处理前明显升高(p(0.05),预处理结束时TNF-α水平较预处理前降低。发生aGVHD、血栓或感染时,TNF-α水平均明显升高,以aGVHD组升高更为明显,血栓组TNF-α升高水平大于感染组(p(0.05)。血栓和aGVHD组的TNF-α水平在发病前2周即有升高,感染组病人在发病前未见改变。IL-1β在移植患者预处理各阶段未见明显变化,发生aGVHD、血栓、感染时IL-1β水平均有升高,以血栓组升高更明显,aGVHD组较感染组也明显升高(p(0.01)。IL-1β水平在血栓患者发病前2周见明显升高,而aGVHD组于发病前1周升高。IFN-γ水平在移植患者预处理过程中未见明显改变,在各并发症组之间变化不明显。结论:异基因造血干细胞移植过程中细胞因子存在着一系列改变,预处理可造成细胞因子TNF-α释放增加。在aGVHD发生时血清TNF-α水平明显升高,且较血栓患者升高更突出;在血栓发生时,血清IL-1β含量明显升高,并高于aGVHD患者。TNF-α、IL-1β水平的升高和移植相关并发症aGVHD及血栓性疾病的发生关系密切。动态监测TNF-α、IL-1β水平可预测aGVHD及血栓性病变的发生。The objective of this study was to investigate the alterations of cytokines TNF-α, IL-1β and IFN-γ at early phase after allogeneic hematopoietic stem cell transplantation and in the course of preconditioning, and to explore the relation of these cytokines with transplant-related complications. Alterations of TNF-α, IL-1β and IFN-γ levels in serum were detected by ELISA in 95 patients received allogeneic hematopoietic stern cell transplantation （ among them 43 cases with GVHD,5 cases with thrombosis,31 cases with infection） and 20 in healthy adults. Alterations of the three cytokines were analyzed during the preconditioning and the early phase after transplantation. The results showed that the TNF-α levels in aGVHD patients underwent allo-HSCT were already higher than that in normal controls before. preconditioning （p 〈 0.01 ）, other patients did not show significant change during this course. TNF-α level in all patients were higher than that at dya 4 of preconditioning, then decreased at end of preconditioning （p 〈 0.05 ）. TNF-α level increased at occurrence of aGVHD, thrombosis and infection, which is most significant in patients with aGVHD, and less significant in patients with infection as compared with patients with thrombosis （p 〈0.05）. TNF-α level began to increase at 2 weeks before aGVHD and thrombosis developed in patients, while TNF-α levels did not change in patients with infection at the same time. IL-1β levels did not change during preconditioning, but increased at time of aGVHD, thrombosis and infection in patients, in which IL-1β levels in patients with thrombosis increased obviously, and more obviously in patients with aGVHD than that in patients with infection （p 〈 0.01 ）. IL-1β levels in patients with aGVHD began to increase at 1 week before aGHVD developed, but IL-1β levels in patients with thrombosis began to increase at two weeks before complication developed. IFN-γ levels did not change in all patients during the process of transplantion. It is con

关 键 词：TNF—α IL-1Β IFN-Γ 异基因造血干细胞移植 急性移植物抗宿主病 血栓 

分 类 号：R457.7[医药卫生—治疗学]