供受体KIR和HLA-Cw基因与无关供体造血干细胞移植后巨细胞病毒激活的相关性

目的 探讨移植物非去T细胞的无关供体造血干细胞移植(HSCT)后患者巨细胞病毒(CMV)激活与供受体杀伤细胞免疫球蛋白样受体(KIR)和HLA-Cw基因的相关性.方法 以2003年1月至2008年12月48例行无关供体HSCT患者为研究对象,采用PCR-SSP和PCR-SSOP方法 检测供受体KIR基因单体型和HLA-Cw位点,免疫组化监测这些患者移植后CMV感染情况.结果 供受体HLA-Cw相合33例,不合15例,CMV激活率分别为48.5%和66.7%,两组比较差异无统计学意义(χ~2=1.39,P=0.2375),供受体均属于HLA-C1组的有37例,均属于HLA-C2组11例,CMV激活率分别为64.9%和18.2%,两组比较差异有统计学意义(χ~2=18.13,P＜0.0001).供体为KIR单体型A的移植有26例,供体为KIR单体型B的移植有22例,CMV激活率分别为57.7%和50.0%,两者比较差异无统计学意义(χ~2=0.28,P=0.5941).供体激活性KIR基因小于、等于受体的激活性KIR基因的有34例,CMV激活率为70.6%,供体激活性KIR基因大于受体激活性KIR基因的有14例,CMV激活率为14.3%,两者比较差异有统计学意义(χ~2=12.44,P=0.0004).结论 在无关供体HSCT中受体和供体不同激活性KIR的数量和HLA-Cw位点差异可能与CMV激活存在相关性.

Relationship between CMV reactivation and KIR haplotype/HLA-Cw genotype in patients after unrelated-donor hematopoietic stem cell transplantation

Objective To explore the relationship between CMV reactivation and KIR haplotype or HLA-Cw genotype in patients after unrelated-donor hematopoietic stem cell transplantation(HSCT).Methods From January 2003 to December 2008 the HLA-Cw/KIR genotype of 48 patient-donor pairs were determined by polymerase chain reaction with sequence specific primers (PCR-SSP) and sequence specific nucleotide (PCR-SSOP).Posttransplant CMV reactivation was performed by immune histochemically assay.Resuits Of 48 patients,15 were transplanted from unrelated donors with an antigen mismatch for HLA Cw and 33 patient-donor pairs were matched for HLA-Cw.The CMV reaction rate was 66.7% for HLA-Cw mismatch group and 48.5% for HLA-Cw match group (χ~2 = 1.39,P =0.2375).Thirty-seven donor-patients pairs belonged to group C1 and 11 to group C2,and CMV reaction rate was 64.9% in group C1 and 18.2% in group C2(χ~2= 18.13,P＜0.0001).Twenty-six patients received graft from KIR haplotype A (group A donor) and 22 from KIR haplotype B donors (group B donor) and CMV reaction rate was 57.7% in group A donor and 50.0% in group B donor (χ~2 =0.28,P =0.5941).The number of donor activating KIRs(aKIRs) was less than that of recipient aKIRs in 34 patient-donor pairs in which the CMV reaction rate was 70.6%,and the number of donor aKIRs was more than that of recipient aKIRs in 14 patient-donor pairs in which the CMV reactivation was 14.3%,There was a significan difference between the two group(χ~2 = 12.44,P = 0.0004).Conclusion KIR and HLA-Cw genotypes influence the rate of CMV reactivation following non-T cell deleted unrelated donor hematopoietie cell transplantation.