异基因造血干细胞移植患者CD4^+T淋巴细胞ATP含量检测及其临床意义  

Detection of ATP Level in CD4^+ T Lymphocytes and Its Clinical Significance in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

作　　者：李莉[1] 刘毅[1] 刘佳欣 赵德峰[1] 郑培浩[1] 尹文杰[1] 马媛媛[1] 钱李仁[1] 王恒湘[2] 高春记[3] 沈建良[1] 

机构地区：[1]海军总医院血液科,北京100048 [2]空军总医院血液科,北京100142 [3]解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2017年第6期1781-1786,共6页Journal of Experimental Hematology

摘　　要：目的:探讨CD4^+ T淋巴细胞三磷酸腺苷(adenosine triphosphate,ATP)含量检测(Immuknow ATP)在异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后早期的临床价值。方法:检测急性白血病患者移植前的CD4^+ T淋巴细胞ATP含量,获得恶性血液病移植前基数值;检测allo-HSCT后3个月时CD4^+ T淋巴细胞的ATP含量,据此进行免疫功能分组,进而分析不同组的临床特征。结果:15例恶性血液病患者移植前CD4^+ T淋巴细胞ATP含量平均值为203.98±112.72(56.21-435.71)ng/ml。46例恶性血液病患者CD4^+ T淋巴细胞的ATP含量为1.69-333.09 ng/ml,中位值41.96 ng/ml。以91.26 ng/ml和316.70 ng/ml为界值,将46例患者分成免疫功能低下组36例(78.3%),中间组8例(17.4%)和增强组2例(4.3%)。免疫功能减低组的感染率显著高于中间组(86.1%vs 50.0%)(P=0.022),也显著高于增强组(86.1%vs 0%)(P=0.002),重症感染发生率在3组之间差异无统计学意义(P>0.05)。免疫功能增强组的Ⅱ度以上急性移植物抗宿主病(acute graft versus host desease,a GVHD)发生率明显高于减低组(100%vs 13.9%)(P=0.002),免疫性器官损伤发生率显著高于减低组和中间组(100%vs 0%vs 0%)(P=0.000;P=0.002)。白血病复发率在3组之间无明显差异。高环孢菌素A(cyclosporine A,CsA)谷浓度的患者比例在3组之间无明显差异(P=0.720)。结论:Allo-HSCT后早期检测CD4^+ T淋巴细胞ATP含量对预测感染、a GVHD严重程度和免疫性器官损伤具有临床价值。Objective： To explore the clinical value of detecting adenosine triphosphate（ ATP） level in CD4^＋ T lymphocytes（ Immuknow ATP） of patients on early stage after allogeneic hematopoietic stem cell transplantation（ allo-HSCT）. Methods： The base-line ATP value in CD4^＋ T lymphocytes in cases of hematological malignancies and the ATP level in CD4^＋ T lymphocytes of acute leukemia patients before allo-HSCT were detected. Allo-HSCT recipients were devided into 3 groups with different level of immunereactivity according to ATP concentraiton in month 3（ day 9 0 ± 5） after allo-HSCT. The clinical characteristics of patients in 3 groups were analyzed. Results：The mass concentration of Immuknow ATP in 15 cases of hematological malignancies before allo-HSCT ranged from 56. 21-435. 71 ng/ml,with a mean of 203. 98 ± 112. 72 ng/ml. The ATP level in 46 cases after allo-HSCT ranged from 1. 69-333. 09 ng/ml,with a median of 41. 96 ng/ml. Both 91. 26 ng/ml（ mean-SD） and 316. 70 ng/ml（ mean ＋ SD） were used as cutoff,and 36 allo-HSCT recipients（ 78. 3%） were assigned to low immunereactivity group,8 recipients（ 17. 4%） to middle group and 2 recipients（ 4. 3%） to high group. The incidence of infection in low immunereactivity group was significantly higher than that in middle immunereactivity group（ 86. 1% vs 50. 0%）（ P = 0. 022）,and also significantly higher than that in high immunereactivity group（ 86. 1% vs 0%）（ P = 0. 002）. There were no statistical differences in the incidences of severe infection among 3 groups. The incidence of grade Ⅱ or higher acute graft versus host disease（ a GVHD） in high immunereactivity group was superior to that in low immunereactivity group statistically（ 100% vs13. 9%）（ P = 0. 002）. Immune-mediated organ injury occurred more frequently in high immunereactivity group as compared with low and middle immunereactivity groups（ 100% vs 0% and vs 0%）（ P = 0. 000; P = 0. 002）. There were no significant differences in relaps

关 键 词：造血干细胞移植 异基因造血干细胞移植 CD4^+ T淋巴细胞 三磷酸腺苷 免疫功能 

分 类 号：R457.7[医药卫生—治疗学]