再生障碍性贫血患者异基因造血干细胞移植后免疫功能重建的研究  

Immune reconstitution of aplastic anemia after allogeneic hematopoietic stem cell transplantation

作　　者：梁敏[1] 莫文健[1] 毛平[1] 潘世毅 张玉平[1] 周铭[1] 张璐[1] 王顺清[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院血液科,510180

出　　处：《中华器官移植杂志》2016年第4期198-202,共5页Chinese Journal of Organ Transplantation

基　　金：广东省省级科技计划项目基金（2014A020212521）

摘　　要：目的对比再生障碍性贫血与恶性血液病的患者异基因造血干细胞移植（allo-HSCT）后1年内免疫功能重建情况，探讨再生障碍性贫血患者移植后免疫功能重建规律。方法选取2013年5个月至2015年10个月接受allo-HSCT的受者92例，分为两组，其中再生障碍性贫血组（研究组）受者50例，恶性血液病组（对照组）受者42例。采用流式细胞仪测定移植后1、2、3、6、12个月的CD16＋CD56＋自然杀伤细胞（NK细胞），CD3＋、CD4＋及CD8＋T淋巴细胞绝对数，以及CD19＋B淋巴细胞的绝对数。采用比浊法检测免疫球蛋白IgM、IgG及IgA水平。移植后6个月内，检测巨细胞病毒（CMV）DNA和EB病毒（EBV）DNA拷贝数，每周2次。结果移植后1个月，研究组受者外周血CD3＋T淋巴细胞、CD8＋T淋巴细胞及CD4＋T淋巴细胞均低于对照组，差异有统计学意义（P〈0．05）。移植后2个月，研究组CD19＋B淋巴细胞低于对照组，差异有统计学意义（P=0．01）。而其他检测时点，两组CD3＋T淋巴细胞、CD8＋T淋巴细胞、CD4＋T淋巴细胞、CD19＋B淋巴细胞、CD16＋CD56＋NK细胞及免疫球蛋白水平的差异均无统计学意义（P〉0．05）。研究组受者CMV、EBV的感染率高于对照组，差异均有统计学意义（P〈0．05）。结论再生障碍性贫血患者allo-HSCT后受者的免疫功能重建有其独特的规律，移植后1个月时的T淋巴细胞及移植后2个月时的B淋巴细胞的重建迟于恶性血液病的患者，且CMV、EBV的感染发生率较高。再生障碍性贫血患者移植后须及早发现与治疗CMV、EBV感染。Objective To reveal the unique immune reconstitution of aplasitic anemia （AA） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） by comparing AA with malignant hematonosis after allo-HSCT within one year. Method Ninety-two patients who received allo-HSCT between May 2013 and October 2015 were studied, including 50 cases of AA and 42 cases of malignant hematonosis. CD16＋ CD56＋ natural killing （NK） cells, T cell subsets （CD3＋, CD4＋, CD8＋ ）, CD19＋ B cells and serum immunoglobulin concentrations （IgM, IgG, IgA） were analyzed by flow cytometry （FCM） and scatter turbidimetry at 1st, 2nd, 3rd, 6th and 12th month after allo-HSCT. The CMV-DNA and EBV-DNA were detected by PCR twice a week, during 6 months after allo- HSCT. Result The number of CD3 ＋ T cells, CD8 ＋ T cells and CD4＋ T cells in AA group was less than in malignant hematonosis group at the first month after allo-HSCT （P〈0. 05）. The number of CD19＋ B cells in AA group was less than in malignant hematonosis group （P = 0. 01）. There was no significant difference in the number of remaining CD3＋ T cells, CD8＋ T cells, CD4＋ T cells, CD19＋ B cells and CD16＋ CD56＋ NK cells between two groups （P〉0. 05）. The incidence of CMV viremia and EBV viremia in malignant hematonosis group was higher than in AA group （P〈0. 05）. Conclusion There＇s unique immune reconstitution for AA after allo-HSCT. The delayed immune reconstitution of AA was showed on T cell subsets at the first month and CD19＋ B cells at second month as compared with malignant hematonosis after allo-HSCT. The incidence of CMV and EBV infections was higher in AA group. So, early diagnosis and early treatment of the CMV and EBV infections were of vital importance, especially for AA after allo-HSCT.

关 键 词：再生障碍性贫血 造血干细胞移植 免疫重建 

分 类 号：R556.5[医药卫生—血液循环系统疾病] R733[医药卫生—内科学]