allo-HSCT后淋巴细胞亚群重建与GVHD及感染的相关性
Association of lymphocyte subset reconstitution with graft-versus-host disease and infection after allogenic hematopoietic stem cell trans-plantation
王淑惠 1慕莹 1韩洁 2魏晓芳 1刘秋媛 1阎丽平1
作者信息
- 1. 青岛大学附属青岛市中心医院检验科,山东青岛 266042
- 2. 青岛大学附属青岛市中心医院血液科,山东青岛 266042
- 折叠
摘要
目的 探讨血液病病人异基因造血干细胞移植(allo-HSCT)后外周血淋巴细胞各亚群的重建规律,以及淋巴细胞各亚群变化与移植后移植物抗宿主病(GVHD)及感染的关系.方法 采用流式细胞术,检测32例allo-HSCT病人清髓处理前3 d和移植后14、30、90、180、365、730 d时的淋巴细胞亚群分布情况,并分析病人GVHD以及感染与淋巴细胞各亚群变化的关系.结果 与移植前比较,血液病病人移植后总淋巴细胞、CD3+T细胞、CD4+T细胞、CD8+T细胞、CD16+CD56+NK细胞、CD19+B细胞重建的速度不同,其中NK细胞恢复最快,不到30 d就恢复至移植前水平;其次为CD8+T细胞,约30 d恢复至移植前水平;CD3+T细胞在移植后60 d基本可以达到移植前水平;而B细胞以及CD4+T细胞恢复较慢,B细胞约360 d恢复至移植前水平,CD4+T细胞在移植后730 d仍未恢复到移植前水平.移植后第90天,发生急性移植物抗宿主病(aGVHD)病人5例,其CD3+T细胞(t'=3.334,P＜0.05)、CD4+T 细胞(t=3.836,P＜0.05)和 CD16+CD56+NK 细胞(t=3.300,P＜0.05)绝对计数均低于非急性移植物抗宿主病(non-aGVHD)组,差异有统计学意义.移植后第365天,发生慢性移植物抗宿主病(cGVHD)病人17例,其CD4+T细胞计数低于非慢性移植物抗宿主病(non-cGVHD)组,差异有统计学意义(t=2.918,P＜0.05).与无感染组(n=5)比较,移植后第180天病毒感染组(n=6)淋巴细胞(t=2.441,P＜0.05)、CD4+T 细胞(t=3.513,P＜0.05)、NK 细胞(t=3.728,P＜0.05)、B 细胞(t=2.937,P＜0.05)降低;细菌感染组(n=8)淋巴细胞(t=2.535,P＜0.05)、CD4+T 细胞(t'=6.726,P＜0.05)降低,CD8+T 细胞升高(t'=-2.945,P＜0.05);真菌感染组(n=4)CD4+T 细胞降低(t=2.579,P＜0.05),CD8+T 细胞升高(t=2.423,P＜0.05);混合感染组(n=9)淋巴细胞(t=2.195,P＜0.05)、CD3+T 细胞(t=2.649,P＜0.05)、CD4+T 细胞(t=3.728,P＜0.05)、CD8+T 细胞(t=2.579,P＜0.05)、B 细胞(t=3.045,P＜0.05)和 NK 细胞(t=2.207,P＜0.05)绝对计数均降低.结论 allo-HSCT后淋巴细胞各亚群的重建以及变化与病人预后相关,应该连续监测病人移植前后外周血淋巴细胞亚群的变化情况.
Abstract
Objective To investigate the reconstitution of lymphocyte subsets in peripheral blood and the relationship be-tween lymphocyte subset changes and graft-versus-host disease(GVHD)and infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with malignant hematologic diseases.Methods Thirty-two patients undergoing allo-HSCT were examined using flow cytometry for the distribution of lymphocyte subsets 3 d before myeloablative conditioning and 14,30,90,180,365,and 730 d after transplantation.The relationship between lymphocyte subset changes and GVHD and infection was analyzed.Results After transplantation,the reconstitution speed of total lymphocytes,CD3+T cells,CD4+T cells,CD8+T cells,CD16+CD56+NK cells,and CD19+B cells differed:NK cells recovered first to the pre-transplant level within 30 d;CD8+T cells around 30 d after transplantation;CD3+T cells around 60 d after transplantation;B lymphocytes around 360 d after transplantation;but CD4+T cells did not recover to the pre-transplant level 730 d after transplantation.On the 90th day after transplantation,5 patients had acute GVHD,whose absolute counts of CD3+T cells(t'=3.334,P＜0.05),CD4+T cells(t=3.836,P＜0.05),and CD16+CD56+NK cells(t=3.300,P＜0.05)were significantly lower compared with those without acute GVHD.On the 365th day after transplantation,17 patients had chronic GVHD,whose CD4+T cell count was significantly lower compared with those without chronic GVHD(t=2.918,P＜0.05).On the 180th day after transplantation,compared with the non-infection group(n=5),the viral infection group(n=6)showed significantly de-creased levels of lymphocytes(t=2.441,P＜0.05),CD4+T cells(t=3.513,P＜0.05),NK cells(t=3.728,P＜0.05),and B cells(t=2.937,P＜0.05);the bacterial infection group(n=8)showed significantly decreased levels of lymphocytes(t=2.535,P＜0.05)and CD4+T cells(t'=6.726,P＜0.05)and significantly increased levels of CD8+T cells(t'=-2.945,P＜0.05);the fungal infection group(n=4)showed significantly decreased CD4+T cell levels(t=2.579,P＜0.05)and significantly increased CD8+T cell levels(t=2.423,P＜0.05);the mixed infection group(n=9)showed significantly decreased absolute counts of lym-phocytes(t=2.195,P＜0.05),CD3+T cells(t=2.649,P＜0.05),CD4+T cells(t=3.728,P＜0.05),CD8+T cells(t=2.579,P＜0.05),B lymphocytes(t=3.045,P＜0.05),and NK cells(t=2.207,P＜0.05).Conclusion The reconstitution and chan-ges of lymphocyte subsets are related to the prognosis of patients after allo-HSCT,and lymphocyte subsets in peripheral blood should be continuously monitored before and after transplantation.
关键词
造血干细胞移植/淋巴细胞亚群/移植物抗宿主病/感染Key words
hematopoietic stem cell transplantation/lymphocyte subsets/graft vs host disease/infections引用本文复制引用
基金项目
山东省自然科学基金青年基金(ZR2022QH269)
出版年
2024
国家科技期刊平台
NSTL
万方数据