CAJ | 학술논문

背景:随着外周血干细胞移植的迅速发展,目前已替代骨髓移植,成为造血干细胞移植的首选方法.由于小儿尤其是低龄低体质量幼儿自身的特殊性,外周血干细胞采集相对困难.目的:观察采用血细胞分离机采集低龄低体质量小儿外周血造血干细胞的安全性及不良反应.方法:采用自体造血干细胞移植治疗2例年龄低于2岁体质量低于15 kg的1型糖尿病患儿.主要方法:进行适当的心理安慰以减轻其对采集的恐惧感.采集前1周常规口服钙剂,减少采集中低钙的发生.采集前24 h禁食油腻食物,采集当天禁食牛奶,以免出现乳糜血液,影响细胞采集.1周前常规口服钙剂,减少采集中低钙的发生.常规锁骨下静脉置管.采集前给予200 mL经照射(25 Gy)的红细胞悬液充盈分离管路,以避免低血容量综合征及减少对红细胞压积的影响.设置个体化的采集参数.采集时循环血量为三、四倍体循环量,以保证足够的循环总量.分离过程中ACD/全血的比例保持在1:11～1:13之间,防止发生枸橼酸钠中毒等.结果与结论:2例患儿外周血干细胞均1次采集成功,采集过程中患儿各项生命体征平稳,无不良反应.采集后单个核细胞分别达14.71×108/kg,18.82×108/kg;CD34+分别达34.13×108/kg,32.38×106/kg.只要做好充分准备,低龄低体质量幼儿外周血干细胞采集是安全可行的.
배경:수착외주혈간세포이식적신속발전,목전이체대골수이식,성위조혈간세포이식적수선방법.유우소인우기시저령저체질량유인자신적특수성,외주혈간세포채집상대곤난.목적:관찰채용혈세포분리궤채집저령저체질량소인외주혈조혈간세포적안전성급불량반응.방법:채용자체조혈간세포이식치료2례년령저우2세체질량저우15 kg적1형당뇨병환인.주요방법:진행괄당적심리안위이감경기대채집적공구감.채집전1주상규구복개제,감소채집중저개적발생.채집전24 h금식유니식물,채집당천금식우내,이면출현유미혈액,영향세포채집.1주전상규구복개제,감소채집중저개적발생.상규쇄골하정맥치관.채집전급여200 mL경조사(25 Gy)적홍세포현액충영분리관로,이피면저혈용량종합정급감소대홍세포압적적영향.설치개체화적채집삼수.채집시순배혈량위삼、사배체순배량,이보증족구적순배총량.분리과정중ACD/전혈적비례보지재1:11～1:13지간,방지발생구연산납중독등.결과여결론:2례환인외주혈간세포균1차채집성공,채집과정중환인각항생명체정평은,무불량반응.채집후단개핵세포분별체14.71×108/kg,18.82×108/kg;CD34+분별체34.13×108/kg,32.38×106/kg.지요주호충분준비,저령저체질량유인외주혈간세포채집시안전가행적.
BACKGROUND:The rapidly developed transplantation of peripheral blood stem cells have been successfully used to substitute bone marrow transplantation and become the first choice method for transplantation of hemopoietic stem cells.It is relatively difficult to collect peripheral blood stem cells from young age and low body mass infants.OBJECTIVE:To investigate the safety and adverse effects of peripheral blood stem cell collection from young age and low body mass through the use of blood cell separator.METHODS:Two type 1 diabetes mellitus infants,aged younger than 2 years old and with body mass less than 15 kg,were treated using autologous hemopoietic stem cell transplantation.The two infants were adequately comforted to lesion the fear of collection.At 1 week prior to collection,calcium agent was orally taken to reduce the incidences of low calcium.Within 24 hours prior to collection,oily food was forbidden,and on the day of collection,milk was forbidden,to avoid chylemia,which influences blood collection.Prior to collection,200 mL 25 Gy y-ray radiated red blood cells suspension was injected into the tube,which was routinely placed in the subclavian vein,to avoid hypovolaemic syndrome and the effects on hematocrit.Individualized collection parameters were set,During collection,blood circulation volume was 3,4 times of systemic blood circulation to ensure sufficient total circulation volume.During isolation,the ratio of ACD to whole blood was kept between 1:11 and 1:13 to prevent sodium citrate poisoning.RESULTS AND CONCLUSION:Peripheral blood stem cells were successfully collected during first intention in each infant.During collection,stable vital signs but no adverse effects were observed.After collection,mononuclear cells weighted 14.71×108/kg and 18.82×108/kg respectively,and CD34+ cells were about 34.13×108/kg and 32.38×106/kg,respectively in each infant.Therefore,it is feasible to collect peripheral blood stem cells from infants of young age and low body mass under sufficient psychological preparation.