细胞因子释放综合征患者中单核细胞计数及其亚群比例的临床分析  

Clinical analysis of monocyte count and subsets proportion in patients with cytokine release syndrome

作　　者：马驭 高丽萍 张焕新 张慧芳 陈伟 程海 李护君 李振宇 徐开林 闫志凌 Ma Yu;Gao Liping;Zhang Huanxin;Zhang Huifang;Chen Wei;Cheng Hai;Li Hujun;Li Zhenyu;Xu Kailin;Yan Zhiling(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院血液科,徐州221006

出　　处：《国际输血及血液学杂志》2024年第6期494-502,共9页International Journal of Blood Transfusion and Hematology

基　　金：江苏省卫健委面上项目(M2022103)。

摘　　要：目的探讨细胞因子释放综合征(CRS)患者接受嵌合抗原受体T细胞(CAR-T)免疫疗法治疗前、后外周血单核细胞计数及其亚群比例的变化。方法选择2019年2月1日至2019年7月31日徐州医科大学附属医院血液科收治的24例接受CAR-T免疫疗法后发生CRS的血液肿瘤患者为研究对象。24例患者中,男性为19例,女性为5例,中位年龄为60岁。根据CRS程度将患者分为1级CRS组(n=13)与≥2级CRS组(n=11);根据患者是否并发细菌感染,将患者分为感染组(n=6)和非感染组(n=18)。1级CRS组与≥2级CRS组,感染组与非感染组患者的年龄、诊断时间、性别、疾病种类、既往治疗线数构成比等基本临床资料分别比较,差异均无统计学意义(均为P>0.05)。采用流式细胞术、细胞因子微球检测(CBA)法分别检测治疗前及治疗后14 d单核细胞免疫表型及相关细胞因子水平。采用回顾性研究方法,收集患者的单核细胞计数及其亚群比例相关数据,分析不同组别及治疗前、后患者相关指标的变化情况。2组患者年龄、诊断时间、白细胞计数(WBC)、单核细胞计数及其亚群比例比较采用Mann-Whitney U检验,不同时间点比较采用Wilcoxon符号秩检验。细胞因子及单核细胞亚群相关性分析采用Spearman秩相关。本研究经徐州医科大学伦理委员会审查(批准文号:XYFY2017-KL013-01、XYFY2017-KL014-01、XYFY2016^(-)KL002-01),并与所有受试者签订临床研究知情同意书。结果①本研究24例接受CAR-T免疫疗法治疗的患者中,14例为多发性骨髓瘤(MM),4例为急性淋巴细胞白血病(ALL),6例为淋巴瘤。24例患者均发生不同程度的CRS,其中13例发生1级CRS,8例为2级CRS,3例为4级CRS。②与治疗前比较,本研究患者治疗后14 d单核细胞计数升高[0.05×10^(9)/L(0.01×10^(9)/L,0.11×10^(9)/L)比0.30×10^(9)/L(0.20×10^(9)/L,0.50×10^(9)/L),Z=3.98,P<0.001],CD14^(++)CD16^(-)单核细胞比例下降[87.1%(71.1%,92.9%)比74.5%(60.1,80.3),Objective To investigate the changes of peripheral blood monocyte count and subset proportion in patients with cytokine release syndrome(CRS)before and after receiving chimeric antigen receptor T cell(CAR-T)immunotherapy.Methods From February 1,2019 to July 31,2019,a total of 24 cases of patients with hematologic tumors who had CRS after receiving CAR-T immunotherapy in Department of Hematology,Affiliated Hospital of Xuzhou Medical University were selected as study subjects.Among 24 patients,19 were males and 5 were females.Median age was 60 years.Patients were divided into grade 1 CRS group(n=13)and≥grade 2 CRS group(n=11)according to CRS degree.And they were divided into infected group(n=6)and non-infected group(n=18)according to whether they had concurrent bacterial infection.There were no significant differences in basic clinical data such as age,diagnosis time,proportion of gender,disease type,previous treatment lines between grade 1 CRS group and≥grade 2 CRS group,as well as between infected group and non-infected group(all P>0.05).Monocyte immunophenotype and related cytokine levels were detected by flow cytometry and cytokine microsphere assay(CBA)before and 14 d after treatment,respectively.A retrospective study method was used to collect the relevant data of monocyte count and its subpopulation proportion of patients,and analyze the changes of relevant indicators of patients in different groups and before and after treatment.Mann-Whitney U test was used to compare age,diagnosis time,white blood cell count(WBC),monocyte count and subsets proportion of patients in the 2 groups,and Wilcoxon sign rank test was used to compare patients at different time points.Spearman rank correlation was used to analyze the correlation between cytokines and monocyte subsets.This study was reviewed by the Ethics Committee of Xuzhou Medical University(Approval No.XYFY2017-KL013-01,XYFY2017-KL014-01,XYFY2016^(-)KL002-01),and all subjects signed informed consent for clinical study.Results①Of the 24 patients treated with

关 键 词：细胞因子释放综合征 单核细胞 单核细胞亚群 细胞因子 免疫疗法 过继 嵌合抗原受体T细胞 

分 类 号：R730.51[医药卫生—肿瘤]