造血干细胞移植患者动态监测胸腺输出功能的意义  

Significance of dynamic monitoring of thymic recent output function in patients with hematopoietic stem cell transplantation

作　　者：孙丽华[1] 孟庆祥[1] 赵林俊[1] 许蕾[1] 王钧[1] 姚志娟[1] 

机构地区：[1]北京大学深圳医院血液科,广东深圳518036

出　　处：《中国医药导报》2013年第19期50-53,共4页China Medical Herald

基　　金：广东省深圳市科技计划项目(编号201202009)

摘　　要：目的观察造血干细胞移植患者胸腺近期输出功能的动态变化情况,分析其相关影响因素,从而了解移植后T细胞免疫重建情况。方法选择2007年1月~2012年6月于北京大学深圳医院接受造血干细胞移植的血液病患者41例,采用实时荧光定量PCR方法检测患者不同时期200μL外周血中T细胞受体重排DNA删除环（sjTREC）水平,计算每毫升血液中sjTREC拷贝数。同时检测32例年龄匹配的正常者外周血T细胞受体重排DNA删除环含量作为正常对照。比较患者造血干细胞移植后sjTREC随时间变化情况。结果 32例正常对照组外周血Log sjTREC/mL为3.78±0.22,它与年龄呈负相关（r=-0.59,P〈0.05）。41例移植患者移植前外周血sjTREC水平显著低于正常对照组,移植后外周血sjTREC进一步下降,移植6个月后TRECs逐渐升高,移植后1.5年基本恢复至移植前水平,移植后2.5年恢复至接近正常水平。反复化疗可使患者胸腺输出功能下降。不同年龄组患者移植后胸腺输出功能恢复差异无统计学意义（P〉0.05）。移植6个月后,自体造血干细胞移植组患者外周血sjTREC水平恢复快于异基因移植组（P〈0.05）,至移植后2年二者差异无统计学意义（P〉0.05）。移植1年后存在广泛型cGVHD的患者其外周血sjTREC水平下降,低于无cGVHD者（P〈0.05）。结论造血干细胞移植后T细胞免疫重建缓慢,并受多种因素影响。胸腺输出功能可作为评价移植后免疫重建的有效指标。Objective To observe the dynamic alterations about recent output function of thymus in patients with hematopoietic stem cell transplantation （HSCT） and analyze its related factors, in order to understand the function of T-cell immune reconstitution after HSCT. Methods 41 patients with HSCT was included in this study from January 2007 to June 2012 in Peking University Shenzhen Hospital. Real time quantitative PCR was used to detect the levels of sjTREC in 200 μL peripheral blood of 41 HSCT patients as well as 32 normal individuals with the similar age as control, and the numbers of sjTREC copies per milliliter in blood were calculated. The sjTREC changes level were compared after hematopoietic stem cell transplantation. Results The mean of Log sjTREC/mL in 32 normal individuals was 3.78±0.22, owning negative correlation with age factor （r = -0.59, P 〈 0.05）. The sjTREC levels in the peripheral blood of 41 cases of patients just before transplantation was significantly lower than the control group, and further declined after transplantation with the lowest after 14 days following transplantation, then began to increase after 6 months, recovered to the basic levels before transplantation after 1.5 years, eventually approached nearly to the normal levels after 2.5 years. Besides, repeated chemotherapy could gradually undermine the thymic output function of patients. No clear distinction in the recovery of thymic output function was observed among different ages patients. The results also indicated that sjTREC levels recovered faster in auto-HSCT patients than in allo-HSCT patients at 6 months after transplantation （P 〈 0.05）, however, with no obvious difference in 2 years after transplantation （P 〉 0.05）. The level of sjTRECs in the peripheral blood of patients with extensive-cGVHD decreased significantly than that in patients with no-cGVHD in 1 year after HSCT （P 〈 0.05）. Conclusion The study shows that the function of thymie output after allo-HSCT recovers very slowly and is influenced

关 键 词：造血干细胞移植 胸腺输出功能 T细胞受体重排删除DNA环 免疫重建 

分 类 号：R392[医药卫生—免疫学]