【摘要】 目的 分析亲缘人类白细胞抗原(HLA)单倍体相合非体外去T细胞高剂量外周血造血干细胞移植(Haplo-HDPSCT)后急性移植物抗宿主病(aGVHD)临床特征，以及程序性死亡受体-1(PD-1)、程序性死亡受体-配体1(PD-L1)在aGVHD后的表达。方法 选取2004年1月-2017年12月采用Haplo-HDPSCT移植模式进行移植的154例患者，分析aGVHD发病率、发生部位，以及发生aGVHD后与PD-1、PD-L1的关系。结果 (1)移植后Ⅰ～Ⅳ度aGVHD的累计发生率为（61.04±3.92）%，其中Ⅱ～Ⅳ度和Ⅲ～Ⅳ度aGVHD的累计发生率为（37.69±4.50）%和(11.69±3.05)%；皮肤型aGVHD的累计发生率最高，其次为肝脏、消化道；(2)在aGVHD患者中，移植后第30天PD-1血清水平高于无aGVHD患者，III～IV度aGVHD患者移植后第60天PD-1血清水平高于无aGVHD患者，PD-1水平预测aGVHD曲线下面积(AUC)在移植后30 d和移植后60 d为0.857(P=0.048)和0.750(P=0.033)。结论采用Haplo-HDPSCT移植模式虽然aGVHD发生率略高，但重度aGVHD发生率无明显增高，发生部位以皮肤为主，表明此种移植模式是可行的。移植后PD-1水平的升高可以预测aGVHD的发生，对临床诊断的确立能提供帮助。更多还原

【Abstract】 Objective To analyze the clinical characteristics of acute graft versus host disease(aGVHD) after related human leukocyte antigen(HLA) haploidentical non T cell-depleted in vitro high dose peripheral blood hematopoietic stem cell transplantation(Haplo-HDPSCT), the expression of programmed cell death-1(PD-1) and programmed cell death-Ligand 1(PD-L1) after aGVHD. Methods 154 patients underwent Haplo-HDPSCT from January 2004 to December 2017 were selected. The incidence rate, location of aGVHD and the relationship between PD-1 and PD-L1 after aGVHD were analyzed. Results(1) the cumulative incidence of aGVHD after transplantation was(61.11±3.9)%,but cumulative incidence of grade Ⅱ～Ⅳ and grade Ⅲ～Ⅳ aGVHD were(36.7 ± 4.5)% and(11.8±3.1)%; cumulative incidence of skin aGVHD was the highest and followed by liver and digestive tract;(2)In patients with aGVHD, the serum level of PD-1 at 30 days after trasnplantation were higher than that in patients without aGVHD,. At 60 days after trasnplantation, the serum level of PD-1 in patients with grade III ～ IV aGVHD was higher than that of the patients without aGVHD. The area under the curve(AUC) covered that PD-1 level to predict the risk of aGVHD were 0.857(P=0.048) and 0.750(P=0.033) on the 30th and 60th days after transplantation. Conclusion Although the incidence of aGVHD was slightly higher in Haplo-HDPSCT protocol, but the occurrence rate of grade III～IV aGVHD was low, the skin was main organs involved in aGVHD, which indicated that transplantation mode was feasible. The increase of PD-1 level after transplantation can predict occurrence of aGVHD and provide help for the establishment of clinical diagnosis.更多还原