【摘要】：目的:探討異基因造血干細(xì)胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)后1年內(nèi)患者體內(nèi)淋巴細(xì)胞亞群變化并分析移植患者年齡、HLA相合情況、移植物抗宿主病、感染并發(fā)癥等對(duì)淋巴細(xì)胞亞群變化的影響。方法:回顧性分析36例2013年3月至2016年4月在重慶醫(yī)科大學(xué)附屬第二醫(yī)院行allo-HSCT患者,用流式細(xì)胞儀檢測患者外周血在移植前、移植后1月、3月、6月、12月時(shí)的淋巴細(xì)胞亞群絕對(duì)計(jì)數(shù)值,觀察各淋巴細(xì)胞免疫表型包括CD3+、CD4+、CD8+、CD19+、CD16+CD56+(NK細(xì)胞)、CD4+CD25+Fox P3+(調(diào)節(jié)T細(xì)胞,Treg細(xì)胞)移植后變化情況,分析患者年齡、HLA相合情況、移植物抗宿主病、感染并發(fā)癥等對(duì)移植前后淋巴細(xì)胞亞群變化的影響。結(jié)果:CD3+T淋巴細(xì)胞移植后1月明顯下降,第3月逐漸恢復(fù),第6月接近移植前水平;CD4+T淋巴細(xì)胞亞群移植后第1月明顯下降,第3月以后逐漸恢復(fù),第12月仍未恢復(fù)到移植前水平;CD8+T淋巴細(xì)胞亞群移植后1個(gè)月下降幅度小于CD4+T淋巴細(xì)胞亞群,移植3月后CD8+T淋巴細(xì)胞數(shù)明顯恢復(fù)并超過移植前水平,12月明顯高于移植前水平;CD4+/CD8+比值在移植后一直呈倒置狀態(tài);CD19+B淋巴細(xì)胞在移植后1個(gè)月明顯低下降,第3月開始緩慢恢復(fù),至6月仍明顯低于移植前水平,至移植后12個(gè)月基本恢復(fù)至移植前水平。NK細(xì)胞在移植后1月無明顯變化,移植后3月逐漸上升并超過移植前水平,第12月明顯超過移植前水平。調(diào)節(jié)性T淋巴細(xì)胞在移植后1月輕微下降,后緩慢上升,到6月達(dá)移植前水平。移植后年齡大于等于40歲及小于40歲組、感染和非感染組各淋巴細(xì)胞亞群計(jì)數(shù)無統(tǒng)計(jì)學(xué)差異,HLA全相合移植淋巴細(xì)胞亞群計(jì)數(shù)恢復(fù)快于單倍體移植組,發(fā)生II-IV度a GVHD患者組CD3+T淋巴細(xì)胞、CD4+T淋巴細(xì)胞亞群、CD19+B淋巴細(xì)胞、NK細(xì)胞計(jì)數(shù)均低于0-I度a GVHD患者組。結(jié)論:異基因造血干細(xì)胞移植受者體內(nèi)各淋巴細(xì)胞亞群計(jì)數(shù)恢復(fù)都有一定的規(guī)律,患者年齡、移植后感染并發(fā)癥不影響免疫重建,a GVHD可能延緩早期淋巴細(xì)胞的恢復(fù),HLA全相合移植相比單倍體移植更有利于淋巴細(xì)胞亞群的恢復(fù)。
[Abstract]:Objective: to investigate the changes of lymphocyte subsets in patients with allogeneic hematopoietic stem cell transplantation (allogeneic hematopoietic stem cell transplantation,allo-HSCT) within one year, and to analyze the age, HLA compatibility and graft versus host disease (GVHD) in patients with allogeneic hematopoietic stem cell transplantation (HSCT). Effects of infection complications on lymphocyte subsets. Methods: a retrospective analysis of 36 patients with allo-HSCT in the second affiliated Hospital of Chongqing Medical University from March 2013 to April 2016 was performed. The peripheral blood was detected by flow cytometry before, 1 month, 3 months and 6 months after transplantation. The absolute count of lymphocyte subsets was measured at 12 months. The changes of lymphocyte immunophenotypes including CD3, CD4, CD8, CD19, CD16 CD56 (NK cells), CD4 CD25 Fox P3 (regulating T cells, Treg cells) were observed, and the age of the patients was analyzed. The effects of graft versus host disease (GVHD) and infection complications on lymphocyte subsets before and after transplantation were observed. Results: CD3 T lymphocytes decreased significantly in 1 month, recovered gradually in the third month, and approached the pre-transplant level in the sixth month. CD4 T lymphocyte subsets decreased significantly in the first month after transplantation, gradually recovered after the third month, and did not return to the pre-transplant level in the 12th month. The decrease of CD8 T lymphocyte subsets was less than that of CD4 T lymphocyte subsets 1 month after transplantation. The number of CD8 T lymphocytes recovered significantly after 3 months of transplantation and exceeded the pre-transplant level, and in 12 months it was significantly higher than that before transplantation. The ratio of CD4 / CD8 was inverted after transplantation. CD19 B lymphocytes decreased significantly at 1 month after transplantation, then recovered slowly in the third month, and were still significantly lower than those before transplantation in June, and basically recovered to pre-transplant level 12 months after transplantation. NK cells did not change significantly at one month after transplantation. The level of pretransplant increased gradually in 3 months after transplantation and exceeded the level before transplantation in the 12th month. Regulatory T lymphocytes decreased slightly in one month after transplantation, then increased slowly, and reached pre-transplant level in June. There was no significant difference in lymphocyte subsets between infected group and non-infected group after transplantation. The subsets of lymphocyte subsets of HLA homozygous transplantation recovered faster than those of haploid transplantation group. The counts of CD3 T lymphocytes, CD4 T lymphocyte subsets, CD19 B lymphocytes and NK cells in patients with II-IV degree a GVHD were lower than those in patients with 0-I degree a GVHD. Conclusion: the recovery of lymphocyte subsets in allogeneic hematopoietic stem cell transplantation recipients has a certain regularity. The age of the patients and the infection complications after transplantation may delay the recovery of lymphocytes in the early stage. HLA homozygous transplantation was more beneficial to the recovery of lymphocyte subsets than haploid transplantation.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R457.7

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