脐带血重建造血潜能的母体及新生儿因素分析

脐带血作为一种备选的移植用造血干细胞,能否成功植入与输入受者体内的总有核细胞（total nucleated cells,TNC）数、CD34＋细胞数及粒-巨噬细胞集落形成单位（colony-forming unit-granulocyte-macrophage,CFU-GM）有关。本研究探讨影响脐带血造血潜能的母体及新生儿因素。按照广州脐血库标准化操作常规（SOP）,对脐带血样本进行筛选、处理、检测及冷冻,回顾性分析已保存的4615份脐带血样本的造血细胞参数及其与母体及新生儿特征的相关性。结果表明：脐带血采集量（Mean±SD：95.23±22.42ml;Median：91.85ml）与处理前TNCMean±SD：（1.34±0.49）×109;Median：1.25×109]及处理后TNCMean±SD：（1.21±0.42）×109;Median：1.14×109]、CD34＋细胞数Mean±SD：（5.14±4.55）×106;Median：4.08×106]、CFU-GMMean±SD：（9.72±8.66）×105;Median：7.53×105]三者均显著相关（p〈0.001）。在供者因素中,只有婴儿出生体重与脐带血采集量及造血细胞参数均呈显著正相关（p〈0.001）,较大婴儿的脐带血在采集量、TNC、CD34＋细胞数及CFU-GM方面均呈现优势（p〈0.001）。母亲年龄与上述各项参数均无显著相关。孕龄与处理前/后TNC正相关（p〈0.001;p〈0.001）,与CD34＋细胞数呈负相关（p=0.04）,而与采集量及CFU-GM均无显著相关。剖宫产时采集的脐带血量虽然高于阴道分娩（Mean±SD：97.05ml±22.23mlvs.92.53ml±22.43ml;Median：94.08mlvs.88.82ml;p〈0.001）,但各细胞参数均低于阴道分娩（p〈0.001）。男婴脐带血的采集量和CD34＋细胞数高于女婴（Mean±SD：96.41ml±22.31mlvs.93.95ml±22.47ml;Median：93.27mlvs.90.14ml;p〈0.001）;Mean±SD：（5.28±5.04）×106vs.（5.00±3.94）×106;Median：4.18×106vs.3.94×106;p=0.042]、但处理前TNC及处理后TNC均低于女婴Mean±SD：（1.31±0.50）×109vs.（1.37±0.47）×109;Median：1.22×109vs.1.28×109;p〈0.001];Mean±SD：（1.18±0.42）×109vs.（1.24±0.41）×109;Median：1.10×109vs.1.17×109;p〈0.001],二者CFU-GM的差异无统计学意义。结论：本研究数据有助于优化脐带血供者筛选及提高脐血库资源利用率。脐血库应侧重选择体重较大、阴道分娩的新生儿供者,优先处理采集量大、TNC高的脐带血样本。

Analysis of Maternal and Neonatal Factors Associated with Hematopoietic Reconstruction Potential in Umbilical Cord Blood Units

Umbilical cord blood （UCB） is an alternative source of hematopoietic stem cells for transplantation with success being associated with the total nucleated cell （TNC） count, CD34＋ cells and colony-forming unit-granulocyte-macrophage（CFU-GM） content infused. This study was purposed to clarify the impact of maternal and neonatal factors on hematopoietic potential of UCB product. UCB samples were screened, processed, tested and cryopreserved according to the Standard Operation Procedure （SOP） of Guangzhou cord blood bank （GZCBB）. Relationship of hematopoietic cell parameters with maternal and neonatal characteristics for 4615 UCB units was analyzed retrospectively. The results showed that both collected volume （Mean±SD： 95.23±22.42 ml; Median： 91.85 ml） and initial TNC Mean±SD： （1.34±0.49）×109; Median： 1.25×109] correlated well with postprocessed TNC Mean±SD： （1.21±0.42）×109; Median： 1.14×109; p0.001], CD34＋count Mean±SD： （5.14±4.55）×106; Median： 4.08×106; p0.001] and CFU-GM content Mean±SD： （9.72±8.66）×105;Median： 7.53×105; p0.001]. As for donor factors, only infant birth weight correlated strongly with volume collected and all hematopoietic cell parameters （p0.001）. UCB samples from bigger babies had higher collected volume, TNC, CD34＋ count and CFU-GM content （p0.001）. Mother＇s age had no correlation with all the above parameters. Gestational age correlated positively with initial/postprocessed TNC （p0.001） and negatively with CD34＋ count （p=0.04）, but no relation with collected volume and CFU-GM content. Cesarean section produced superior volume （Mean±SD： 97.05±22.23 ml vs 92.53±22.43 ml; Median： 94.08 ml vs 88.82 ml; p0.001）, but inferior cell count than vaginal delivery （p0.001）. Male infants had more initial volume and CD34＋ count （Mean±SD： 96.41±22.31 ml vs 93.95±22.47 ml; Median： 93.27 ml vs 90.14 ml; p0.001）; Mean±SD： （5.28±5.04）×106 vs （5.00±3.94）×106; Median： 4.18×106 vs 3.94×106; p=0.042], but lower initial and postprocessed TNC than female ones Mean±SD： （1.31±0.50）×109 vs （1.37±0.47）×109; Median： 1.22×109 vs 1.28×109; p0.001]; Mean±SD： （1.18±0.42）×109 vs （1.24±0.41）×109; Median： 1.10×109 vs 1.17×109; p0.001], while no significant difference of CFU-GM were found between male and female infants. It is concluded that these data may be helpful to optimize the UCB donor selection and improve cost efficiency of UCB bank resource. The heavier infants after vaginal delivery should be selected and large-volume units with higher TNC should be chosen at first.