本文選題：造血干細(xì)胞移植 + 自體移植��； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2016年03期

【摘要】：目的:探討異基因造血干細(xì)胞移植(allogenic hematopoietic stem cell transplantation,allo-HSCT)和自體造血干細(xì)胞移植(autologous HSCT,auto-HSCT)患者早期免疫重建的異同。方法:收集2011年12月至2014年8月在北京大學(xué)第三醫(yī)院血液科進(jìn)行HSCT的惡性血液病患者31例,其中15例allo-HSCT,16例auto-HSCT;留取20名健康人外周血標(biāo)本作為健康對(duì)照。采用四色流式細(xì)胞術(shù)檢測(cè)兩組患者移植后1年內(nèi)外周血中淋巴細(xì)胞亞群的動(dòng)態(tài)變化,并通過(guò)檢測(cè)T細(xì)胞受體重排刪除環(huán)(T cell receptor rearrangement excision circle,TREC)水平判斷初始T細(xì)胞功能。結(jié)果:移植后12個(gè)月內(nèi)allo-HSCT組和auto-HSCT組患者CD4+T細(xì)胞、CD8初始T細(xì)胞、效應(yīng)記憶性T細(xì)胞、CD4中樞記憶性T細(xì)胞、中期活化性T細(xì)胞以及DC重建與健康對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組患者間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),CD8+T細(xì)胞和NK細(xì)胞迅速恢復(fù)正常水平。移植后前3個(gè)月內(nèi)B細(xì)胞重建在兩組患者間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),均顯著低于健康對(duì)照組(P0.01),但從第6個(gè)月起auto-HSCT組顯著快于allo-HSCT組患者(P0.05);移植后第6個(gè)月起allo-HSCT組晚期活化性T細(xì)胞表達(dá)顯著高于auto-HSCT組(P0.05),而auto-HSCT組CD4初始T細(xì)胞和CD8中樞記憶性T細(xì)胞的表達(dá)高于allo-HSCT組(P0.05)。移植后12個(gè)月內(nèi)allo-HSCT和auto-HSCT組患者外周血CD3+T細(xì)胞中TREC水平顯著低于年齡相近的健康對(duì)照組(P0.05),allo-HSCT組患者外周血CD3+T細(xì)胞中的TREC水平稍高于auto-HSCT組患者,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:allo-HSCT和auto-HSCT患者早期免疫重建的速度和特點(diǎn)很相似,移植患者免疫重建主要不是由異源性移植物所決定,可能與胸腺功能受損后T細(xì)胞分化緩慢密切相關(guān)。
[Abstract]:Objective: to investigate the differences and similarities of early immune reconstitution between allogenic hematopoietic stem cell transplantationallo-HSCT and autologous HSCTauto-HSCT in patients with allogenic hematopoietic stem cell transplantation (HSCT) and autologous hematopoietic stem cell transplantation (HSCT).Methods: from December 2011 to August 2014, 31 patients with malignant hematological diseases, including 15 patients with allo-HSCT and 16 patients with auto-HSCT, were collected from hematology department of the third Hospital of Peking University.Four color flow cytometry (FCM) was used to detect the dynamic changes of lymphocyte subsets in peripheral blood of the two groups within one year after transplantation, and to determine the initial T cell function by detecting the T cell receptor rearrangement excision circle level of T cell receptor rearrangement.Results: within 12 months after transplantation, the CD4 T cells in allo-HSCT group and auto-HSCT group had the initial CD8 T cells, and the effector memory T cells were CD4 central memory T cells.The difference of activated T cells and DC reconstruction between the two groups was statistically significant (P 0.05), but there was no significant difference between the two groups in the level of CD8 T cells and NK cells.In the first 3 months after transplantation, there was no significant difference between the two groups in B cell reconstruction, both of which were significantly lower than that of the healthy control group (P 0.01), but from the 6th month the auto-HSCT group was significantly faster than that of the allo-HSCT group, and the late stage of the allo-HSCT group was alive from the 6th month after transplantation.The expression of chemotypic T cells was significantly higher than that of auto-HSCT group (P 0.05), while the expression of CD4 initial T cells and CD8 central memory T cells in auto-HSCT group was higher than that in allo-HSCT group.Within 12 months after transplantation, the level of TREC in peripheral blood CD3 T cells in allo-HSCT and auto-HSCT group was significantly lower than that in control group (P 0.05). The level of TREC in peripheral blood CD3 T cells in allo-HSCT and auto-HSCT group was slightly higher than that in auto-HSCT group, but the difference was not statistically significant (P 0.05).Conclusion the rate and characteristics of early immune reconstruction in patients with auto-HSCT and W / allo-HSCT are similar. The immune reconstruction in transplant patients is not mainly determined by allografts and may be closely related to the slow differentiation of T cells after thymic dysfunction.
【作者單位】： 北京大學(xué)第三醫(yī)院血液科;
【分類號(hào)】：R457.7

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