儿童再生障碍性贫血异基因造血干细胞移植术后免疫重建的临床研究

doi:10.3969/j.issn.1006-6233.2022.01.031

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摘要 目的:探讨再生障碍性贫血(AA)患儿异基因造血干细胞移植术(allo-HSCT)后免疫重建规律及与急性移植物抗宿主病(aGVHD)关系。方法:回顾性分析2017年12月至2019年12月在郑州大学第一附属医院儿童医院血液干细胞移植中心行allo-HSCT 34例AA患儿移植后第1、3、6、12个月时的淋巴细胞亚群比例,并以15例健康儿童为参照。同时对比无aGVHD组及有aGVHD组的淋巴细胞亚群比例有无差别。结果:CD3⁺细胞、CD8⁺细胞比例在造血干细胞移植术后第1、3、6、12个月均高于健康对照组,差异有统计学意义(P<0.05),呈逐渐下降趋势。CD4⁺细胞比例、CD4⁺/CD8⁺在移植后第1、3、6、12个月均低于于健康对照组,差异有统计学意义(P<0.05),呈逐渐上升趋势。B细胞比例在移植后第1、3、6个月均低于健康对照组,差异有统计学意义(P<0.05),呈逐渐上升趋势,在第12个月与健康对照组相比无统计学差异(P>0.05)。NK细胞比例在移植后第1个月高于健康对照组,差异有统计学意义(P<0.05),其后与健康对照组相比无统计学差异(P>0.05)。无aGVHD组与有aGVHD组相比,CD3⁺细胞、CD8⁺细胞比例在第1、3个月较低,NK细胞比例较高,差异有统计学意义(P<0.05)。CD4⁺细胞比例、CD4⁺/CD8⁺、B细胞比例两组间在第1、3个月无统计学差异(P>0.05)。结论:再生障碍性贫血患儿造血干细胞移植术后早期免疫重建以CD3⁺细胞、CD8⁺细胞及NK细胞为主,较高的CD8⁺细胞及较低NK细胞比例患儿易出现aGVHD。

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关键词 ：免疫重建, 再生障碍性贫血, 异基因造血干细胞移植, 儿童

Abstract：Objective: To study the immunological reconstruction of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children with aplastic anemia (AA) and the relationship with the acute graft-versus-host disease (aGVHD). Methods: From December 2017 to December 2019, 34 patients with AA underwent allo HSCT in the blood stem cell transplantation center of children's Hospital of the First Affiliated Hospital of Zhengzhou University. The lymphocyte subsets of 34 AA children in 1st, 3rd, 6th and 12th month after transplantation were analyzed retrospectively, and 15 healthy children were taken as reference. At the same time, the proportion of lymphocyte subsets between the group without aGVHD and the group with aGVHD was compared. Results: The proportion of CD3⁺ cells and CD8⁺ cells in the 1st, 3rd, 6th and 12th month after hematopoietic stem cell transplantation were higher than those in the healthy control group (P<0.05), showing a gradual downward trend. The percentage of CD4⁺ cells and the ratio of CD4⁺/CD8⁺ in the 1st, 3rd, 6th and 12th month after transplantation were lower than those in the healthy control group (P<0.05). The proportion of B cells in the 1st, 3rd, 6th month after transplantation was lower than that in the healthy control group, the difference was statistically significant (P<0.05), showing a gradual upward trend, and there was no significant difference between the two groups at the 12th month (P>0.05). The percentage of NK cells in the 1st month after transplantation was significantly higher than that in the healthy control group (P<0.05), but there was no significant difference between the two groups (P>0.05). The proportion of CD3⁺ cells and CD8⁺ cells in the non aGVHD group was lower than that in the aGVHD group in the 1st, 3rd months, and the proportion of NK cells was higher (P<0.05). The ratio of CD4⁺ cells, CD4⁺/CD8⁺ and B cells between the two groups had no significant difference in the 1st, 3rd month (P>0.05). Conclusion: CD3⁺ cells, CD8⁺ cells and NK cells are the main immune reconstitution after hematopoietic stem cell transplantation in children with aplastic anemia. AGVHD is easy to occur in children with higher proportion of CD8⁺ cells and low proportion of NK cells.

Key words： Immune reconstruction Aplastic anemia Allogeneic hematopoietic stem cell transplantation Child

基金资助:河南省医学科技攻关省部共建重点项目,(编号:SBGJ202002114)

通讯作者: 王叨

引用本文:

游红亮, 汤苗苗, 李欢欢, 刘玉峰, 王叨. 儿童再生障碍性贫血异基因造血干细胞移植术后免疫重建的临床研究[J]. 河北医学, 2022, 28(1): 151-154.
YOU Hongliang, TANG Miaomiao, LI Huanhuan, et al. Clinical Study of Immune Reconstruction After Allogenic Hematopoietic Stem Cell Transplantation in Children with Aplastic Anemia. HeBei Med, 2022, 28(1): 151-154.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.01.031 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I1/151

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