恶性血液病患者异基因外周血干细胞移植后免疫功能的随访研究

 目的　探讨恶性血液病患者异基因外周血干细胞移植（allo-PBSCT）后免疫功能重建的规律，及时指导移植后感染的防治。方法　采用间接免疫荧光法测定34例恶性血液病患者在接受allo-PBSCT后外周血T（CD3、CD4、CD8）、B（CD19）、NK（CD56）细胞亚群的动态变化。结果　allo-PBSCT后+1个月时各T淋巴细胞亚群（CD3、CD4、CD8）较正常都有显著下降（P＜0.05），CD+3细胞在+3个月时开始逐渐上升，至+12个月时基本达到正常，CD+4细胞在+6个月时基本达到正常，CD+8细胞在+3个月时已达正常，CD+4／CD+8在移植后较正常均无显著下降（P＞0.05），仅在+6个月时呈倒置；CD+19和CD+56细胞在移植后+1个月时仅有轻度下降，在移植+3个月时均超过正常。全相合和半相合组的T、B、NK细胞亚群在+1个月、+6个月、+12个月时相比差异均无统计学意义，且在移植后+3个月时，半相合组的CD+3、CD+8细胞显著高于全相合组（P＜0.05），而CD+4／CD+8显著低于全相合组。在移植后+1个月时伴慢性移植物抗宿主病（cGVHD）组的CD+4细胞显著高于无cGVHD组（P＜0.05），其他时间段两组各淋巴细胞亚群差异均无统计学意义（P＞0.05）。结论　allo-PBSCT免疫重建的速度较异基因骨髓移植（allo-BMT）快，且HLA的不相容性以及cGVHD的发生均对免疫重建无重大影响。

The kinetic study on the immune reconstitution after allogeneic peripheral blood stem cell transplantation

Objective To study the recovery of the peripheral lymphocyte subsets in patients underwent allogeneic peripheral blood stem cell transplantation (allo-PBSCT) and guide the prevention and treatment of infection. Methods Indirect immunofluorescence assay was used to detect the lymphocyte subsets, such as T cell subsets (CD3, CD4, CD8). B cell (CD19) and natural killer cell(CD56) at 1, 3, 6, 12, 18months post transplantation, in the meantime, lymphocyte subsets of 32 samples from healthy blood donors were tested as normal control values. Results CD+3, CD+4 and CD+8 ceils significantly decreased than that of normal control at 1 month post transplantation, the recovery of CD+3 T cells was within 3-12 months, CD+4 and CD+8 T cells recovered to normal at 6 months and 3 months post transplantation respectively, CD+4/CD+8 ratio were not significantly lower than that of normal control at different stages, CD+4/CD+8 ratio reversed only at 6 months post transplantation. CD+19 and CD +56 T cells recovered quickly and they were more than normal proportion at 3 months post transplantation. The CD+3, CD+8 T cells and CD+4/CD+8 ratio were statistically higher in HLA haploidentical allo-PBSCT patients than that in HLA identical allo-PBSCT at 3 months post transplantation. There were no difference between the two groups at 1, 6, 12, 18 months post transplantation.The patients with cGVHD had significantly higher CD+4 cells than those without cGVHD at 1 month after transplantation. There was no significant difference in all of the lymphocyte subsets at 3, 6, 12, 18 months after transplantation between them. Conclusion Allo-PBSCT has a hastened immune reconstitution, which was not delayed by the incompatibility of HLA and the development of cGVHD.