丹参酮联合rhG-CSF动员高龄健康供者外周血造血干细胞的效果分析

目的研究丹参酮联合重组人粒细胞集落刺激因子(rhG-CSF)方案对高龄健康供者外周血造血干细胞的动员效果。方法回顾性分析2008年11月至2010年12月采用丹参酮联合rhG-CSF和单用rhG-CSF动员方案,动员高龄健康供者外周血造血干细胞的效果。其中丹参酮联合rhG-CSF组34例,单用rhG-CSF组31例;年龄45～60岁,平均49.6岁。中位体质量61.2kg(49.5～79.0kg)。给予丹参酮注射液(40mL/d)联合rhG-CSF 10μg.kg-1.d-1,或单用rhG-CSF 10μg.kg-1.d-1行外周血干细胞动员。动员第5天采集外周血单个核细胞(MNC),检测MNC和CD34+细胞数。采集外周血干细胞于当日输注给患者(预处理结束后24h)。结果丹参酮联合rhG-CSF组中30例供者1次采集充足,4例采集2次,平均采集MNC数6.7(5.9～14.3)×108/kg,CD34+细胞3.9(2.7～8.3)×106/kg;单用rhG-CSF组中22例1次采集充足,9例采集2次及以上,平均采集MNC数5.3(4.6～11.9)×108/kg,CD34+细胞数3.1(2.1～6.7)×106/kg,两组比较差异均有统计学意义(P<0.05)。造血干细胞移植预处理后所有患者均达到明显骨髓抑制,丹参酮联合rhG-CSF组供者中性粒细胞恢复到0.5×109/L时间为12.4(10～17)d,血小板(PLT)恢复到20×109/L时间为14.2(13～18)d;单用rhG-CSF组供者中性粒细胞恢复到0.5×109/L时间为12.8(10～18)d,PLT恢复到20×109/L时间为14.8(13～19)d,两组比较差异均无统计学意义(P>0.01)。结论丹参酮联合rhG-CSF动员方案可显著提高异基因造血干细胞移植高龄健康供者外周血干细胞动员效果,保证移植后造血功能的重建。对于高龄供者是一种安全有效的动员造血干细胞的方法,临床效果满意,值得推广。

Curative effect of tanshinone combined with rhG-CSF on mobilization of peripheral blood stem cells in elderly healthy donors

Objective To study the curative effect of tanshinone combined with recombinant human granulocyte colony stimulating factor(rhG-CSF) on mobilization of peripheral blood stem cells in elderly healthy donors.Methods A retrospective study of autologous peripheral blood stem cell mobilization by tanshinone combined with rhG-CSF or single rhG-CSF in patients from November 2008 to December 2010 was analyzed.Mobilization efficacy of peripheral blood stem cells was detected.34 patients were treated with rhG-CSF and tanshinone,and 31 patients were treated with rhG-CSF only,age of 45-60 years,mean age of 49.6 years.The median weight was 61.2 kg(49.5-79.0 kg).Tanshinone(40 mL/d) combined with rhG-CSF(10 μg·kg-1·d-1) or single rhG-CSF(10 μg·kg-1·d-1) was used to mobilize peripheral blood stem cells.In the fifth day after mobilization,peripheral blood mononuclear cells were collected,and the number of MNC and CD34+ cells was detected.Peripheral blood stem cells were infused to patients on the same day(24 h after pretreatment).Results In tanshinone combined with rhG-CSF group,the average number of MNC was 6.7(5.9-14.3)×108/kg,and that of CD34+cells was 3.9(2.7-8.3)×106/kg.In rhG-CSF group,the average number of MNC was 5.3(4.6-11.9)×108/kg(P<0.05),and that of CD34+cells was 3.1(2.1-6.7)×106/kg(P<0.05).After treatment,all patients showed obvious bone marrow suppression.In tanshinone combined with rhG-CSF group,the time that the number of neutrophil recovered to 0.5×109/L needed was 12.4(10-17)days,and the time that the number of PLT recovered to 20×109/L needed was 14.2(13-18)days.In rhG-CSF group,the time that the number of neutrophil recovered to 0.5×109/L needed was 12.8(10-18)d(P>0.01),and the time that the number of PLT recovered to 20×109/L needed was 14.8(13-19)d(P>0.01).Conclusion Tanshinone combined with rhG-CSF mobilization program can significantly improve the effects of peripheral blood stem cell mobilization in elderly health donors with allogeneic hematopoietic stem cell transplantation,and ensure the reconstruction of hematopoietic function after transplantation.It is a safe and effective method of mobilizing hematopoietic stem cells for the elderly donors and worth for generalization.