CD3^+ CD4^+ T细胞计数在重型再生障碍性贫血患者异基因造血干细胞移植术后病毒感染的预示价值  

Value of CD3^+ CD4^+ T Cell Count in Prediction of Viral Infection after Hematopoietic Stem Cell Transplantation in Patients Severe Aplastic Anemia

作　　者：莫文健[1] 孙倩倩 潘世毅 毛平[1] 陈小卫[1] 张玉平[1] 周铭[1] 许艳丽[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内科,广东广州510180

出　　处：《中国实验血液学杂志》2017年第6期1761-1767,共7页Journal of Experimental Hematology

基　　金：广东省省级科技计划项目基金(2014A020212521)

摘　　要：目的:探讨重型再生障碍性贫血(SAA)患者在异基因造血干细胞移植(allo-HSCT)后CD3^+ CD4^+ T细胞对预测病毒感染的价值。方法:选广州市第一人民医院血液内科2014年1月至2016年5月SAA行allo-HSCT患者78例。用流式细胞术检测移植后第1、2、3、6、12个月外周血CD3^+ CD4^+ T细胞计数,并根据结果分为<50/μl(n=120)、50-100/μl(n=48)和>100/μl 3个组(n=123)。在时间点的前后2周,监测巨细胞病毒、EB病毒DNA的感染情况,计算各类感染发生率。移植后3个月,按移植患者的CD3^+ CD4^+ T细胞计数分为2组,>100/μl组(n=30)及≤100/μl组(n=48),计算2组的CMV和EBV感染率、持续时间及发病情况,并进行随访,行生存情况比较。结果:CD3^+ CD4^+ T细胞计数>100/μl组较50-100/μl和<50/μl组的CMV、EBV感染率下降。移植后第3个月,CD3^+ CD4^+ T细胞计数>100/μl组CMV及EBV感染率较≤100/μl组低,CMV感染持续时间缩短;移植后3月,CD3^+ CD4^+ T细胞绝对数>100/μl组生存情况优于≤100/μl组。结论:SAA患者allo-HSCT后,CD3^+ CD4^+ T细胞数恢复至100/μl以上时,CMV及EBV感染率明显下降。移植后第3个月,CD3^+ CD4^+ T细胞绝对数>100/μl时CMV及EBV感染率明显下降,CMV感染持续时间缩短,生存率较高。CD3^+ CD4^+ T细胞绝对数是SAA患者alloHSCT后良好的CMV及EBV感染的一个预示指标。Objective： To explore the value of CD3^＋ CD4^＋ T cell count in prediction of viral infections after allogeneic hematopoietic stem cell transplantation（ allo-HSCT） in the patients with severe aplastic anemia（ SAA）. Methods： A total of 78 SAA patients with allo-HSCT in Guangzhou First People＇s Hospital from January 2014 to July 2016 were enrolled in this study. The absolute numbers of CD3^＋ CD4^＋ T cells were measured by flow cytometry at 1,2,3,6,and 12 month after allo-HSCT. According to the cell counts,the patients were divided into 3 groups： i. e. 50/μl（ n =120）,50-100/μl（ n = 48） and 100/μl（ n = 123） groups. The infection incidences of human cytomegalovirus（ HCMV） and Epstein-Barr virus（ EBV） within 2 weeks around each time point were compared between different groups. According the counts of CD3^＋ CD4^＋ T cells at 3 months after-transplant,these patients were divided into 2 groups,i. e. 100/μl（ n = 30） and ≤ 100/μl（ n = 48）. The incidences and duration of HCMV and EBV infection,overall survival rate were compared between 2 groups. Results： The incidences of CMV and EBV infection significantly decreased in CD3^＋ CD4^＋ T cell〉 100/μl group as compared with 50/μl and 50-100/μl groups. At 3 months after-transplant,there was lower incidence rates of CMV disease,EBV infection,shorter durations of CMV infection and better survival in CD3^＋ CD4^＋ T cell〉 100/μl group as compared with ≤100/μl group. Conclusion： CD3^＋ CD4^＋ T cell count is a good predictor for CMV and EBV infection after allo-HSCT in SAA patients. There are low risk of infe-ctions from CMV and EBV when CD3^＋ CD4^＋ T cell count 100/μl in any time after transplant,which means lower occurrence of CMV and EBV infection and better survival when CD3^＋ CD4^＋ T cell counts is 100/μl in 3 months after transplant in SAA patients.

关 键 词：CD3^+ CD4^+ T细胞计数 重型再生障碍性贫血 异基因造血干细胞移植 巨细胞病毒 EB病毒 

分 类 号：R556.5[医药卫生—血液循环系统疾病] R457.7[医药卫生—内科学]