CAJ | 학술논문

目的探讨同胞人类白细胞抗原(HLA)全相合骨髓和外周血造血干细胞混合移植(allo-HSCT)后CMV特异性细胞毒性T细胞(CTL)的重建规律.方法选取17例接受allo-HSCT的血液病患者,采用流式细胞术检测移植后CMV特异性CTL及其亚群数量,酶联免疫斑点(ELISPOT)法检测重建CTL分泌IFN-γ的功能,采用基因扫描方法对移植后受者TCR Vβ亚家族进行克隆性分析,并研究CTL重建与CMV感染的关系.结果移植受者CMV特异性CTL数量和功能均可在移植后30 d重建至正常对照水平,并且在移植后12个月TCR Vβ亚家族已大部分呈多克隆表现.随访期间该组患者移植后CMV感染发生率为35.83%(17.91%～63.10%),均未发生CMV病,当发生CMV感染时外周血CMV特异性CTL中枢记忆T细胞(CD45RO+CD62L+)亚群数量明显增多.结论血液病患者接受同胞HLA相合骨髓和外周血造血干细胞混合移植后,其CMV特异性CTL数量及功能均能早期重建,CMV感染和CMV病发生率较低.
목적 탐토동포인류백세포항원(HLA)전상합골수화외주혈조혈간세포혼합이식(allo-HSCT)후CMV특이성세포독성T세포(CTL)적중건규률.방법 선취17례접수allo-HSCT적혈액병환자,채용류식세포술검측이식후CMV특이성CTL급기아군수량,매련면역반점(ELISPOT)법검측중건CTL분비IFN-γ적공능,채용기인소묘방법대이식후수자TCR Vβ아가족진행극륭성분석,병연구CTL중건여CMV감염적관계.결과 이식수자CMV특이성CTL수량화공능균가재이식후30 d중건지정상대조수평,병차재이식후12개월TCR Vβ아가족이대부분정다극륭표현.수방기간해조환자이식후CMV감염발생솔위35.83%(17.91%～63.10%),균미발생CMV병,당발생CMV감염시외주혈CMV특이성CTL중추기억T세포(CD45RO+CD62L+)아군수량명현증다.결론 혈액병환자접수동포HLA상합골수화외주혈조혈간세포혼합이식후,기CMV특이성CTL수량급공능균능조기중건,CMV감염화CMV병발생솔교저.
Objective To investigate the regular pattern of Cytomegalovirus(CMV)-specific T cells(CTL) immune reconstitution after human leukocyte antigen(HLA) matched sibling donor allogeneic bone marrow(BM) plus peripheral blood hematopoietic stem cell(PBSC) transplantation. Methods CTL from seventeen patients after transplantation was detected by flow cytometry, the IFN-γ secretion ability of CTL by enzyme-linked immunospot(ELISPOT) assay, and clonal analysis of TCR Vβ subfamily by gene scan assays. The relationship between CTL reconstitution and CMV infection was studied. Results Both number and function of recipients CTL reached to normal control level at 30 d post-transplantation.The recipients achieved a high frequency CTL with IFN-γ response and restoration of T-cell receptor β (TCR Vβ) repertoire at one year post-transplantation. CTL with the central memory CD45RO+CD62L+ cell phenotype expanded in PB when CMV was reactivated. The incidence of CMV reactivation was 35.83%(17.91%-63.10%) after transplantation, and none of them developed CMV disease. Conclusion After HLA matched related donor transplantation using mixed grafts, immune recovery to CMV seems to be early and fast.The incidence of CMV infection and disease are lower.