急性移植物抗宿主病患者白细胞介素21水平的变化

回顾性分析2003-03/2007-01哈尔滨市第一医院骨髓移植科行异基因造血干细胞移植治疗的白血病患者20例，男8例，女12例，年龄8~55岁。其中慢性粒细胞白血病4例，急性粒细胞白血病(M2) 5例，急性粒单细胞白血病(M4) 2例，急性单核细胞白血病(M5) 3例，急性淋巴细胞白血病6例。15例外周血干细胞移植只有1例HLA-CW位点亚型不合，其余HLA全部相合，1例无关骨髓移植HLA全部相合。观察全部患者急性移植物抗宿主病的发病情况，移植前后定期采集20例患者外周血，采用双夹心酶联免疫吸附法检测其细胞因子白细胞介素21的水平。结果显示异基因造血干细胞移植后20例患者全部获得造血功能重建，中性粒细胞恢复到0.5×109 L-1，血小板恢复到20×109 L-1的中位时间分别为移植后13.5 d 及18 d。发生急性移植物抗宿主病患者的白细胞介素21水平较移植前及未发生患者明显升高(P < 0.01)。提示检测异基因造血干细胞移植后患者血清白细胞介素21水平有助于预测急性移植物抗宿主病的发生。

Interleukin-21 level changes in patients with acute graft versus host disease

A total of 20 leukemia patients, comprising 8 males and 12 females, aged 8-55 years, who underwent allogeneic hemopoietic stem cell transplantation (allo-HSCT), were enrolled from Department of Bone Marrow Transplantation, First Hospital, Harbin Medical University from March 2003 to January 2007 for retrospective analysis. There were 4 cases of chronic myelocytic leukemia, 5 cases of acute myeloblastic leukemia M2 type, 2 cases of acute myeloblastic leukemia M4 type, 3 cases of acute myeloblastic leukemia M5, and 6 cases of acute lymphoblastic leukemia. Of the 15 patients undergoing peripherial blood stem cell transplantation, HLA-CW site subtype was incompatible in 1 case; HLA was all compatible in the remaining cases; Unrelated bone marrow transplantation HLA was all cormpatible in 1 case. Occurrence of acute graft versus host disease was observed in all patients. Peripheral blood of 20 patients was collected before and after transplantation. The concentration of interleukin-21 was detected by double sandwich enzyme-linked immunosorbentassay. The haematogenesis of 20 patients recovered after allogeneic hemopoietic stem cell transplantation. The median-time that neutrophilic granulocyte recovered to 0.5×109/L was 13.5 days, and the median-time that platelet recovered to 20×109/L was 18 days. The concentration of interleukin-21 in patients with acute graft versus host disease was significantly increased compared to that before transplantation and patients without acute graft versus host disease (P < 0.01). Serum interleukin-21 detection is beneficial for prediction of acute graft versus host disease in patients following allo-HSCT.