儿童急性白血病淋巴细胞变化与化疗和感染相关性探讨

目的 分析儿童急性白血病化疗后外周血中淋巴细胞的变化,探讨淋巴细胞值异常与患儿继发免疫紊乱,导致感染及重症感染发生之间的关系。方法 急性淋巴细胞白血病(ALL)27例,急性髓性白血病(AML)9例,经化疗骨髓持续缓解(CCR)9-12个月和21-24个月,外周血白细胞≥4.0×109／L时,用流式细胞仪、单克隆抗体(美国BD公司)分别检测患儿外周血中CD3+、CD4+、CD8+、CD19+、CD16／56+细胞的百分数,进行统计分析。结果 1.随着化疗次数的增加,机体的免疫活性细胞会受到不同程度损害,T细胞亚群的比例明显失调,CD4+细胞百分数下降(P<0.01),CD8+细胞百分数上升(P<0.05),CD4+／CD8+细胞比值严重倒置(P<0.01),CD19+细胞百分数下降(P<0.05),临床上常见白血病患儿易感染和多发严重感染亦与此有关。2.CD16／56+标记的自然杀伤细胞并不随化疗次数增加而有变化(P>0.05),在白血病的治疗中有重要意义。3.AML外周血中CD3+、CD4+、CD8+、CD4+／CD8+、CD19+、CD16+／56+细胞百分数无改变(P>0.05)。结论 ALL患儿免疫活性细胞随着化疗次数的增加受到明显影响,有必要尽早进行免疫干预治疗,以提高患儿机体的免疫功能,以增强抗感染能力,恢复机体的免疫监督能力。对CD19+细胞减少,在感染发生时,给与丙种球蛋白,可减轻感染程度。

Study on a relationship of peripheral lymphocyte changes after the chemotherapy and infection in children with acute leukemia

Objective Study of the changes in lymphocytes in peripheral blood after the chemotherapy for children's acute leukemia is to present the relationship between the abnormal values of lymphocytes and the secondary immunodeficiency that results in severe infections. Method By the means of fluent cytocounting and single - clone antibody (provided by BD ltd, from U.S.A.), a test of CD3+CD4 + CD8 + CD19 + CD16 +/56 + percentages of lymphocytes in the patients peripheral blood was carried out and analysed statistically among 27 cases of acute lymphocytic leukemia (ALL) and 9 of acute myelocytic leukemia (AML) , whose continuous complete relieve (CCR) after chemotherapy and white cell accounts (≥4.0 ×109/L) lasted 9-12 months and 21-24 months respectively. Result 1. Along with more chemotherapy. The patients immunoac-tive cells suffered from damages to a different extent, which showed significant unbalance in T - cell subgroup ratio, decreased percentage of CD4 + cells ( P < 0.01) , increased percentage of CD8 + cells (P < 0.05) ,severe invert of CD4 + /CD8 + (P < 0.01) and decreased percentage of CD19 + cells (P < 0.05) . All these pertained to susceptibility and severity of infections in children's leukemia clinically. 2. It was significant in leukemia treatment that natural kill cells marked by CD16 + /CD56 + did not vary as chemotherapy increased (P>0.05). 3 AML cases indicated no variation of CD3 + CD4+ CD8 + CD4+/CD8+ CD19+ CD16 + / CD56 + percentage of lymphocytes in peripheral blood(P < 0.05). Conclusion In ALL cases the patients' immunoactive cells were injured much more as chemotherapy increased. It was necessary that immunotherapy should be committed as soon as possible to enhance the patients' immunofunction, to strengthen their anti -infection capability and to recover their immunosupervision. In an infection with decreased CD19 + cells, im-munoglobulin could be applied to relieve its severity.