儿童异基因造血干细胞移植后细胞免疫重建的临床研究  

Clinical research on cellular immune reconstitution after allogeneic hematopoietic stem cell transplantation in children

作　　者：宋娜[1] 孙鸣 祁闪闪 王卓 杨李 卢文婕 吴旻 夏维 陈燕[1] 熊昊[1] SONG Na;SUN Ming;QI Shanshan;WANG Zhuo;YANG Li;LU Wenjie;WU Min;XIA Wei;CHEN Yan;XIONG Hao(Department of Hematology&Oncology,Wuhan Children’s Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430016,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院血液肿瘤科,湖北武汉430016

出　　处：《临床儿科杂志》2022年第5期388-394,共7页Journal of Clinical Pediatrics

基　　金：武汉市卫建委2020年度科研项目(No.WX20D20)。

摘　　要：目的探讨儿童异基因造血干细胞移植(allo-HSCT)后免疫重建的临床特性。方法选取2019年7月至2020年10月接受allo-HSCT且临床资料完整的患儿为研究对象。动态监测患儿移植后第0、14、21、28、60及100 d外周血淋巴细胞亚群(CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、CD16^(+)CD56^(+)NK细胞、CD19^(+)B细胞、CD4^(+)CD25^(+)Treg细胞)绝对计数;将患儿按有无急性移植物抗宿主病(aGVHD)分为non-aGVHD组和aGVHD组,比较两组间淋巴细胞亚群的差异。结果共75例患儿接受allo-HSCT,其中移植后满100 d、临床资料完整的42例患儿纳入本研究,男20例、女22例,中位年龄5.4(2.8~9.3)岁。移植前后不同时间点之间患儿CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞、CD16^(+)CD56^(+)NK细胞、CD19^(+)B细胞、CD4^(+)CD25^(+)Treg细胞水平以及CD4^(+)/CD8^(+)比值差异均有统计学意义(P<0.05)。其中CD16^(+)CD56^(+)NK细胞恢复最快,在移植后21 d基本可达到移植前水平;CD3^(+)T细胞在移植后60 d基本可以达到移植前水平,CD8^(+)T细胞到移植后60 d已超过移植前水平。42例患儿中发生aGVHD 16例,aGVHD发生的中位时间为20.0(6.0~36.0)d。移植后28 d和60 d,aGVHD组CD16^(+)CD56^(+)NK细胞绝对计数均低于non-aGVHD组,差异有统计学意义(P<0.05)。结论儿童allo-HSCT后淋巴细胞亚群中重建最早的为CD16^(+)CD56^(+)NK细胞。NK细胞重建与aGVHD的发生密切相关,或有助于早期识别aGVHD患儿。Objective To investigate the clinical characteristics of immune reconstitution after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in children.Methods Children with complete clinical data who received allo-HSCT in the department of hematology and oncology from July 2019 to October 2020 were selected as the study subjects.The absolute count of peripheral blood lymphocyte subsets(CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,CD16^(+)CD56^(+)NK cells,CD 19^(+)B cells,CD4^(+)CD25^(+)Treg cells)was dynamically monitored on day 0,14,21,28,60 and 100 after transplantation.The children were divided into non-aGVHD group and aGVHD group according to the presence or absence of acute graft-versus-host disease(aGVHD),and the differences of lymphocyte subsets between the two groups were compared.Results A total of 75 children received allo-HSCT,and 42 of them with complete clinical data after 100 days of transplantation were included in this study.There were 20 boys and 22 girls with a median age of 5.4(2.8~9.3)years.There were statistically significant differences in the levels of CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,CD16^(+)CD56^(+)NK cells,CD19^(+)B cells,CD4^(+)CD25^(+)Treg cells and CD4^(+)/CD8^(+)ratio at different time points before and after transplantation(P<0.05).CD16^(+)CD56^(+)NK cells recovered the earliest and reached the level of pre-transplantation at 21 days post-transplantation.CD 3^(+)T cells almost reached the pre-transplantation level at 60 days after transplantation,while CD8^(+)T cells exceeded the pre-transplantation level at 60 days after transplantation.The aGVHD occurred in 16 of 42 children,and the median time of aGVHD occurrence was 20.0(6.0-36.0)days.At 28d and 60d after transplantation,the absolute count of CD16^(+)CD56^(+)NK cells in aGVHD group was lower than that in non-aGVHD group,the difference was statistically significant(P<0.05).Conclusions CD16^(+)CD56^(+)NK cells were the earliest lymphocyte subsets reconstructed after allo-HSCT in children.NK cell reconstitution i

关 键 词：异基造血干细胞移植 淋巴细胞亚群 急性移植物抗宿主病 儿童 

分 类 号：R733[医药卫生—肿瘤] R457.7[医药卫生—临床医学]