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本研究观察并比较急性淋巴细胞白血病及急性髓系白血病患者经HLA不全相合非清髓造血干细胞移植(NST)后免疫重建及其与感染和移植物抗宿主病(GVHD)的关系。6名急性淋巴细胞白血病(ALL),4名急性髓系白血病(AML)患者有HLA不全相合亲缘供者,接受以氟达拉滨,ATG,阿糖胞苷,环磷酰胺,TBI2Gy为主的非清髓预处理方案,移植前后给予环孢霉素A或他克莫司联合霉酚酸酯防治GVHD。采用流式细胞术分别于移植前化疗缓解期,移植后监测患者体内的总T细胞、辅助/诱导T细胞、抑制/杀伤T细胞、γ/δT细胞、CD4/CD8比值,B细胞、NK细胞、NKT细胞、调节T细胞、活化T细胞、原始T细胞、记忆T细胞移植后变化规律,分析各免疫功能细胞与移植后感染及急、慢性GVHD的关系;比较ALL与AML免疫系统恢复差别。结果表明,移植后患者各淋巴细胞量恢复有各自规律,发生GVHD患者各淋巴细胞亚群数量较高,而移植后1个月γ/δT细胞、调节T细胞、NK细胞量较低。移植后2-3月时CD4/CD8、B细胞、NK细胞、原始T细胞较低。6-8个月时B细胞,原始T细胞,NK细胞较低。移植后早期发生感染患者总T细胞及各淋巴亚群恢复较慢,NK,NKT细胞数恢复较快,移植后3个月出现感染的患者,其B细胞及原始T细胞量恢复较快。ALL与AML患者淋巴细胞恢复无差异。结论:不全相合NST后各淋巴细胞亚群分析可间接反映患者胸腺功能恢复状态,NK、B细胞、原始T细胞的变化对区分和监测GVHD及感染有重要意义。
This study was designed to observe and compare the immune reconstitution of acute myeloid leukemia and acute myeloid leukemia patients with HLA-incompatible non-myeloablative hematopoietic stem cell transplantation (NST) and its relationship with infection and graft versus host disease (GVHD). Six patients with acute lymphoblastic leukemia (ALL) and four patients with acute myeloid leukemia (AML) had HLA-incompatibility partners and received fludarabine, ATG, cytarabine, cyclophosphamide, and TBI2Gy Non-myeloablative preconditioning regimen, cyclosporine A or tacrolimus combined with mycophenolate mofetil before and after transplantation to prevent and treat GVHD. Flow cytometry was used in the pre-transplant chemotherapeutic remission stage. Total T cells, helper / inducing T cells, killer / killer T cells, γ / δT cells, CD4 / CD8 ratio, B cells and NK cells , NKT cells, regulatory T cells, activated T cells, primitive T cells and memory T cells after transplantation. The relationship between immune cells and post-transplantation infection and acute and chronic GVHD was analyzed. The immune system recovery between ALL and AML was compared. The results showed that each lymphocyte volume recovery had its own rules after transplantation. The number of each lymphocyte subsets in patients with GVHD was higher than that in GVHD patients, and the number of γ / δ T cells, T cells and NK cells were lower at 1 month after transplantation. From 2 to 3 months after transplantation, CD4 / CD8, B cells, NK cells and primitive T cells were lower. 6-8 months when B cells, primitive T cells, NK cells lower. The total T cells and lymphocyte subpopulations recovered slowly in patients with early posttransplantation, the numbers of NK and NKT cells recovered rapidly, and the patients with infected at 3 months posttransplant recovered their B cells and primitive T cells rapidly. There was no difference in lymphocyte recovery between ALL and AML patients. CONCLUSION: Analysis of lymphocyte subpopulations after incomplete NCC coincidence can indirectly reflect the recovery of thymus in patients. The changes of NK, B cells and primitive T cells are important for differentiating and monitoring GVHD and infection.