白血病患儿大剂量化疗后不同阶段免疫学状态的变化  

Study on the immunological reconstruction in children with acute lymphoblastic leukemia after intensive chemotherapy

作　　者：段渊[1] 胡亚美[1] 潘凯枫[1] 周彤[1] 张联[1] 吕有勇[1] 

机构地区：[1]首都医科大学附属北京儿童医院血液病中心,北京100045

出　　处：《中华微生物学和免疫学杂志》2001年第3期272-274,共3页Chinese Journal of Microbiology and Immunology

摘　　要：目的　对 189例不同治疗阶段和 31例初治白血病患儿外周血标本进行了研究 ,以探讨小儿ALL经大剂量化疗后免疫重建的机制。方法　分别用流式细胞术间接免疫荧光法和高敏感双抗体夹心法对儿童白血病细胞表面标志和细胞因子表达水平进行检测。结果　用药后不同阶段的T辅助细胞亚群CD4均较对照组明显降低 (P <0 .0 0 0 1)。T杀伤 /抑制亚群CD8在用药初期较对照组明显增高 ,停药几年后才恢复到正常水平 (P <0 .0 0 0 1)。CD4/CD8明显倒置 (P <0 .0 0 0 1)。B细胞早期标志CD19在用药初无明显变化 ,停药后反而呈升高趋势 (P =0 .0 0 0 9)。T细胞的另一亚群之一Tα/ β在用药后也呈上升趋势 (P =0 .0 186 )。而白血病患儿用药前后NK细胞却无明显变化 (P =0 .2 846 )。与对照组相比 ,白血病患儿不同治疗阶段外周血细胞因子表达水平的差异有显著性。在白血病发病初期 ,IL 2、IL 3、IL 12、TNF α和IFN γ均显著降低。IL 2、IL 3用药期间其表达水平最低 (P <0 .0 1) ,随病情的进展呈规律变化趋势 ,停药 2～ 3年后才达正常水平。IL 4、IL 10在初治阶段表达较高 (P值分别小于 0 .0 0 1、0 .0 1) ;而在整个病情进展期间其表达却维持在较低水平。IL 6在白血病初治阶段表达水平较高 (P <0 .0 0 1)。IL 12和IFN γ在用药?Objective To study on the mechanisms of immunological reconstruction in acute lymphoblastic leukemia (ALL) children followed chemotherapy. Methods The CD markers and cytokines were analyzed for their levels by indirect immune fluorescence with flow cytometry and ELISA in 189 ALL children at different stages of therapy and in 31 ALL children before therapy. Results The level of CD4 decreased significantly during different phases of therapy (P<0.0001), but CD8 increased at the early stage of therapy (P<0.0001) and restored normal after suspension of therapy for several years. The level of one of T lymphocyte subgroups——Tα/β increased markedly (P=0.0186). The CD19 level of B cells didn′t change but increased after suspending therapy (P=0.2846). The expression of IL-2 and IL-3 were the lowest among cytokines tested during therapy and restored normal after suspending therapy for 2-3 years. At the early stage of therapy, the expression of IL-4 and IL-10 were higher (P<0.001, P<0.01, respectively), and IL-6 was higher during the period of induction(P< 0.001). The IL-12 and IFN-γ increased during therapeutic period and decreased after suspension of therapy. Conclusion Making use of monitoring the levels of tumor immune related factors (CD and cytokines) stated in the paper, we could evaluate that to what extent the immunological reconstruction has been established in these ALL children during chemotherapeutical treatment.

关 键 词：白血病 表面标志 细胞因子 免疫重建 药物疗法 

分 类 号：R733.7[医药卫生—肿瘤] R730.3[医药卫生—临床医学]