SAA患者单倍体造血干细胞移植后T淋巴细胞重建特点及与aGVHD关系分析  

The Characteristics of T Lymphocyte Reconstitution after Haploid Hematopoietic Stem Cell Transplantation in SAA and Its Relationship with aGVHD

作　　者：田倩 朱秋娟[1] 王涛[1] 贡蓉 田卫伟[1] 高志林[1] TIAN Qian;ZHU Qiu-Juan;WANG Tao;GONG Rong;TIAN Wei-Wei;GAO Zhi-Ling(Department of Hematopathology,The Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi College of Medical Sciences,Tongji Shanxi Hospital),Taiyuan 030032,Shanxi Province,China)

机构地区：[1]山西医科大学第三医院(山西白求恩医院,山西医学科学院,同济山西医院)血液科,山西太原030032

出　　处：《中国实验血液学杂志》2023年第2期532-538,共7页Journal of Experimental Hematology

摘　　要：目的:探讨接受单倍体造血干细胞移植的重型再生障碍性贫血(SAA)患者T细胞亚群恢复特点及其与急性移植物抗宿主病(aGVHD)的关系。方法:回顾性分析2018年6月至2022年1月在山西白求恩医院血液科接受单倍体造血干细胞移植的29例SAA患者的临床资料。分析所有患者移植前、移植后d 14、21、30、60、90和120的CD3^(+)T、CD4^(+)T、CD8^(+)T淋巴细胞绝对数以及CD4^(+)T/CD8^(+)T比值,并比较无aGVHD发生组、发生Ⅰ-Ⅱ及Ⅲ-Ⅳ度aGVHD组的T淋巴细胞计数情况。结果:27例患者移植后14、21 d所有T细胞计数均远低于正常水平,但存在明显异质性,且T细胞免疫恢复与预处理方案、年龄、移植前免疫抑制剂治疗有一定的关系。CD3^(+)T细胞计数在移植后30、60、90和120 d呈稳定上升趋势,移植后120 d恢复至正常水平;较快的CD4^(+)T细胞恢复与aGVHD密切相关,其在移植后30、60、90、120 d呈缓慢上升趋势,移植后120 d仍远低于正常水平;CD8^(+)T细胞计数在移植后14、21 d开始恢复,且恢复早于CD4^(+)T细胞,在移植后30、60 d呈快速上升趋势,在移植后90 d已超过正常水平。由于CD8^(+)T细胞重建较快,而CD4^(+)T细胞重建缓慢,使移植后长期CD4^(+)T/CD8^(+)T细胞比值倒置。aGVHD组在移植后各个时间段CD3^(+)T、CD4^(+)T、CD8^(+)T细胞淋巴细胞绝对数明显高于无aGVHD组;aGVHD组中,Ⅲ-Ⅳ度aGVHD多发生在移植后早期(14-21 d之内),Ⅰ-Ⅱ度aGVHD组多发生在移植后30~90 d之内,且Ⅲ-Ⅳ度aGVHD组中CD3^(+)T、CD4^(+)T、CD8^(+)T细胞计数明显高于Ⅰ-Ⅱ度aGVHD组;且CD4^(+)T占比较大,aGVHD程度越严重。结论:SAA患者单倍体移植后T细胞免疫重建快慢不一,与预处理方案、年龄、移植前免疫抑制剂治疗有一定关系,CD4^(+)T细胞恢复过快与aGVHD的发生密切相关。Objective:To investigate the recovery characteristics of T cell subsets in patients with severe aplastic anemia(SAA)who received haploid hematopoietic stem cell transplantation(HSCT)and its relationship with acute graft-versus-host disease(aGVHD).Methods:The clinical data of 29 SAA patients who received haploid hematopoietic stem cell transplantation in the department of hematology,Shanxi Bethune Hospital from June 2018 to January 2022 were retrospectively analyzed.The absolute counts of CD3^(+)T,CD4^(+)T,CD8^(+)T lymphocytes and the ratio of CD4^(+)T/CD8^(+)T lymphocytes in all patients before transplantation,14,21,30,60,90 and 120 days after transplantation were analyzed.The proportion of T lymphocytes was compared in the non-aGVHD group,the gradeⅠ-ⅡaGVHD group and the grade III-IV aGVHD group.Results:The counts of all T cells in 27 patients were far below the normal level at 14 and 21 days after transplantation,but there was obvious heterogeneity.There was a certain relationship between T cell immune reconstitution and conditioning regimen,age,and immunosuppressive treatment before transplantation.CD3^(+)T cells showed a steady upward trend at 30,60,90,and 120 days after transplantation,and returned to the normal levels at 120 days after transplantation;faster recovery of CD4^(+)T cells was closely related to aGVHD,which was at 30,60,90,120 days after transplantation showed a slow upward trend,and which was still far below the normal level of 120 days after transplantation.CD8^(+)T cell counts began to recover at 14 and 21 days after transplantation,and the recovery was earlier than the CD4^(+)T cells,and its recovery speed was rapid 30 and 60 days after transptantation,which showed an upward trend and exceeded the normal levels 90 days after transplantation.Since CD8^(+)T cells reconstituted quickly,while the CD4^(+)T cells reconstitution was slowly,which made the long-term CD4^(+)T/CD8^(+)T cell ratio after transplantation was inverted.Compared with the non-aGVHD group,the absolute counts of CD3^(+)T,CD4

关 键 词：单倍体造血干细胞移植 重型再生障碍性贫血 免疫重建 急性移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学] R556.5[医药卫生—临床医学]