自体外周血造血干细胞移植术后免疫重建及免疫治疗的临床研究

目的观察自体外周血造血干细胞移植术后免疫重建和免疫治疗情况.方法选择56例2001年3月～2003年5月自体外周血干细胞移植患者,分别以血常规中淋巴细胞百分比、绝对计数,血清球蛋白含量,CD3 、CD4 、CD8 细胞百分比及CD4 /CD8 为观察指标,监测移植后淋巴细胞数量和功能的恢复情况.以大剂量IL-2作为移植后免疫治疗药物,观察治疗后感染和本病复发情况.结果移植前血清球蛋白含量、淋巴细胞百分比和计数与移植后1个月存在显著性差异,而与移植后3个月的统计结果无显著性差异.移植后1个月CD8 淋巴细胞比例即恢复正常,但CD4 细胞明显低于正常,CD4 /CD8 明显低于移植前.56例患者中12例死于感染和疾病复发,其余患者已无病存活5～30个月,其中6例患者出现带状疱疹感染,经抗病毒治疗后痊愈.结论造血干细胞移植后,患者淋巴细胞计数及功能均较移植前明显减低.以IL-2为主的免疫治疗,作用较肯定,且无严重毒副作用,适于临床广泛应用.

Clinical efficacy of immune reconstitution and immunotherapy after autologous peripheral blood stem cell transplantation

Objective To study immune reconstitution and immunotherapy after autologous peripheral blood stem cell transplantation. Methods Fifty-six cases of patients after APBSCT were detected the count and proportion of lymphocyte, content of serum globulin, proportion of CD4 and CD8 lymphocyte and CD4 /CD8 .Meanwhile, they were treated with IL-2. Results There were significant differences in content of serum globulin,count and proportion of lymphocyte,proportion of CD3 , CD4 lymphocyte and CD4 /CD8 before and after APBSCT one month. The proportion of CD8 lymphocyte increased quickly and came to the level before APBSCT after transplantation one month. Of the patients, twelve died of infection or disease relapse three to eighteen months post-transplantation, and other patients are still alive and disease-free survival for five to thirty months.Conclusion The count and function of lymphocyte have obvious reducction after APBSCT. High dose IL-2 has define therapeutic effect and no serious ill effect, fitted clinical widespread.