【摘要】 目的探讨血液恶性肿瘤患者异基因造血干细胞移植(allo-HSCT)后CD4+T细胞免疫重建及其与侵袭性真菌感染(IFI)的关系。方法选取2010年2月—2014年10月滨州医学院附属医院行allo-HSCT的血液恶性肿瘤患者47例,以同期体检健康者40名作为对照组。分别于移植后1、2、3个月采用流式细胞术检测患者移植后免疫细胞亚群数,采用酶联免疫吸附试验(ELISA)检测细胞因子浓度。观察患者移植后IFI发生情况,及其与CD4+T细胞免疫重建的相关性。结果移植后CD4+T细胞及其免疫细胞亚群数随时间递增,但移植后3个月免疫细胞亚群数仍低于对照组;与对照组比较,移植后白细胞介素(IL)-6和IL-10水平升高,转化生长因子(TGF)-β水平降低;IFI发生率为19.15%(9/47)。多因素Logistic回归分析结果显示,IFI可能与辅助性T细胞(Th)17的细胞数有关,而与Th1、Th2、调节性T细胞细胞数以及IL-6、IL-10、TGF-β和干扰素(IFN)-γ水平无关。结论 CD4+T细胞免疫重建延迟、Th17细胞数明显减少可能与allo-HSCT后IFI的发生有关。更多还原

【Abstract】 Objective To investigate the immune reconstitution of CD4+ T cells after allogeneic hematopoietic stem cell transplantation(allo-HSCT) and its correlation with invasive fungal infection(IFI) in patients with hematological malignancy. Methods A total of 47 patients with hematological malignancy and undergoing alloHSCT in Binzhou Medical University Hospital from February 2010 to October 2014 were enrolled. A total of 40 healthy subjects were enrolled as control group. After transplantation for 1,2 and 3 months,the count of immune subpopulation and concentration of cytokines were determined by flow cytometry and enzyme-linked immunosorbent assay(ELISA),respectively. The incidence of IFI after transplantation and its correlation with immune reconstitution of CD4+ T cells were observed. Results The counts of CD4+ T cells and immune subpopulation increased progressively after transplantation,and the immune subpopulation count after transplantation for 3 months was lower than that in control group. Compared with control group,the levels of interleukin(IL)-6 and IL-10 after transplantation increased,while that of transforming growth factor(TGF)-β decreased. The incidence rate of IFI was 19.15%(9/47). Multivariate Logistic regression analysis showed that IFI might be related to helper T cell(Th)17 cell count instead of Th1,Th2 and regulatory T cell counts as well as IL-6,IL-10,TGF-β and interferon(IFN)-γ levels. Conclusions After allo-HSCT,the immune reconstitution of CD4+ T cells delays,and Th17 cell count decreases obviously,which may be related to the occurrence of IFI.更多还原