异基因造血干细胞移植后白血病复发患者临床及免疫细胞亚群特征分析  

Characterization of clinical and immune cell subpopulations in leukemia patients with recurrence after allogeneic hematopoietic stem cell transplantation

作　　者：赵玮 陈曼 王卉 Zhao Wei;Chen Man;Wang Hui(Department of Transplantation,Beijing Lu Daopei Hospital,Beijing 100176,China;Laboratory Department,Hebei Yanda Lu Daopei Hospital,Langfang 065201,China)

机构地区：[1]北京陆道培医院移植科,北京100176 [2]河北燕达陆道培医院检验科,廊坊065201

出　　处：《中华检验医学杂志》2025年第3期352-356,共5页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨异基因造血干细胞移植(allo-HSCT)后患者外周血淋巴细胞亚群特征对白血病复发的意义及价值。方法回顾性队列研究。收集2021年4月1日至2023年12月31日北京陆道培医院收治的115例allo-HSCT白血病患者,其中复发患者26例,未复发患者89例。男性65例,女性50例,年龄为33(20,50)岁。采用流式细胞技术定期监测患者移植后外周血淋巴细胞亚群即总淋巴细胞、B淋巴细胞、T淋巴细胞、NK细胞、CD4+Treg细胞、CD3+CD4+CD8+T细胞、CD3+CD4-CD8-T细胞、CD28T细胞,讨论其在复发组患者中检测的意义。两组间比较采用χ^(2)检验。对单因素分析有统计学意义的指标再进行二元Logistic回归分析。结果与非复发组患者相比,复发组患者复发前外周血中总淋巴细胞(458.5<1003个/μl,U=1118.00,P=0.004)、B淋巴细胞(4<51个/μl,U=687.00,P<0.001)、T淋巴细胞(320.5<721个/μl,U=746.00,P=0.006)、CD4+T淋巴细胞(57<150个/μl,U=629.50,P<0.001)、CD8+T淋巴细胞(240<468个/μl,U=1150.00,P=0.017)、CD3+CD4-CD8-T细胞(5<32.5个/μl,U=259.00,P<0.001)、CD8+CD28+T细胞(92<298个/μl,U=294.00,P=0.002)、CD4+CD28+T细胞计数(43<141个/μl,U=245.50,P<0.001)、CD8+CD28+T细胞占CD8+T细胞百分比(63.3<70.9%,U=331.00,P=0.006)、CD4+CD28+T细胞占CD4+T细胞百分比(86.1<97.3%,U=313.50,P=0.003)均更低,CD4+Treg细胞计数(2.5>8个/μl,U=635.00,P<0.001)更高,上述两组间差异均有统计学意义。患者移植后外周血中CD8+CD28+T细胞占CD8+T细胞百分比为复发的重要独立危险因素,ROC曲线结果显示AUC=0.724(>0.7,P<0.01),临界值为66.89,敏感度0.733,特异度0.613。结论外周血中低CD8+CD28+T细胞占CD8+T细胞百分比对于移植后复发有一定的提示预警意义。应用流式细胞术移植后定期监测患者外周血免疫细胞亚群,有助于了解患者免疫重建状态。Objective To explore the significance and value of peripheral blood lymphocyte subpopulation characteristics in patients with leukemia recurrence after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A retrospective cohort study was conducted on 115 leukemia patients with allo HSCT admitted to Beijing Ludaopei Hospital from April 1,2021 to December 31,2023,including 26 relapsed patients and 89 non-relapsed patients,65 males and 50 females aged 33(20,50)years old.Flow cytometry was used for regular monitoring of the post-transplantation peripheral blood lymphocyte subpopulations in the patients,i.e.total lymphocytes,B-lymphocytes,T-lymphocytes,NK-cells,CD4+Treg-cells,CD3+CD4+CD8+T-cells,CD3+CD4-CD8-T-cells,CD28 T-cells.The significance of lymphocyte subpopulation detection in the relapsed group of leukemia patients was further discussed.Theχ^(2)test was used for comparison between the two groups.Indicators statistically significant in one-way analysis were then analyzed by binary logistic regression analysis.Results Compared with patients in the non-relapse group,patients in the relapse group had lower total lymphocytes(458.5<1003/μl,U=1118.00,P=0.004),B lymphocytes(4<51/μl,U=67.00,P<0.001),T lymphocytes(320.5<721/μl,U=746.00,P=0.006),CD4+T lymphocytes(57<150/μl,U=629.50,P<0.001),CD8+T lymphocytes(240<468/μl,U=1150.00,P=0.017),CD3+CD4-CD8-T cells(5<32.5/μl,U=259.00,P<0.001),CD8+CD28+T cells(92<298/μl,U=294.00,P=0.002),CD4+CD28+T cell counts(43<141/μl,U=245.50,P<0.001),CD8+CD28+T cells as a percentage of CD8+T cells(63.3<70.9%,U=331.00,P=0.006),and CD4+CD28+T cells as a percentage of CD4+T cells(86.1<97.3%,U=313.50,P=0.003),while the CD4+Treg cell count(2.5>8/μl,U=635.00,P<0.001)was higher.The percentage of CD8+CD28+T cells to CD8+T cells in the peripheral blood of patients after transplantation was a significant independent risk factor for relapse,and the results of the ROC curve showed an AUC of 0.724(P<0.01),with a decision value of 66.89,a sensitivity of 0.733,and a specificity o

关 键 词：白血病 复发 异基因造血干细胞移植 淋巴细胞亚群 流式细胞术 

分 类 号：R733.7[医药卫生—肿瘤]