CAJ | 학술논문

背景：脐血中富含造血干/祖细胞，有很强的增殖、分化及形成集落的能力，在刺激骨髓造血功能、提高血细胞活力和数量、促进免疫细胞发育成熟，维持机体免疫平衡等方面发挥重要作用。 　　目的：探讨自体脐血单个核细胞移植对早产儿免疫功能及预后的影响。 　　方法：选取2010年7月至2012年7月出生立即入住NICU病房，体质量≤1500 g的早产儿62例，根据患儿家长自愿性原则分为治疗组和对照组；治疗组娩出后立即经脐静脉穿刺收集脐血，4h内送中心实验室密度梯度离心后回输早产儿体内；治疗前后监测细胞免疫、体液免疫指标及相关临床指标。 　　结果与结论：治疗组治疗1周复查时细胞免疫指标 CD4、CD4/CD8水平较前明显升高，较对照组比较差异有显著性意义(P=0.01，0.03)，而CD8变化不明显。治疗1周后两组早产儿的体液免疫指标IgM水平均较治疗前升高，但以对照组升高明显(P=0.00)；IgA水平改变不明显，IgG水平下降，以对照组下降明显(P=0.02)；住院期间，治疗组的重症感染发病率为13%，较对照组(16%)低，但差异无显著性意义；治疗组需机械通气患儿比例、平均住院时间与对照组比较差异有显著性意义(P <0.05)。两组早产儿均随访至12个月，治疗组中反复呼吸道感染的发病人数为0例，而对照组为1例，两者比较差异有显著性意义(P<0.05)。结果表明自体脐血干细胞移植有利于改善机体细胞免疫功能，减慢IgG下降水平，减少呼吸机的使用率，缩短住院时间，减低小婴儿的反复呼吸道感染的发病率。
배경：제혈중부함조혈간/조세포，유흔강적증식、분화급형성집락적능력，재자격골수조혈공능、제고혈세포활력화수량、촉진면역세포발육성숙，유지궤체면역평형등방면발휘중요작용。 　　목적：탐토자체제혈단개핵세포이식대조산인면역공능급예후적영향。 　　방법：선취2010년7월지2012년7월출생립즉입주NICU병방，체질량≤1500 g적조산인62례，근거환인가장자원성원칙분위치료조화대조조；치료조면출후립즉경제정맥천자수집제혈，4h내송중심실험실밀도제도리심후회수조산인체내；치료전후감측세포면역、체액면역지표급상관림상지표。 　　결과여결론：치료조치료1주복사시세포면역지표 CD4、CD4/CD8수평교전명현승고，교대조조비교차이유현저성의의(P=0.01，0.03)，이CD8변화불명현。치료1주후량조조산인적체액면역지표IgM수평균교치료전승고，단이대조조승고명현(P=0.00)；IgA수평개변불명현，IgG수평하강，이대조조하강명현(P=0.02)；주원기간，치료조적중증감염발병솔위13%，교대조조(16%)저，단차이무현저성의의；치료조수궤계통기환인비례、평균주원시간여대조조비교차이유현저성의의(P <0.05)。량조조산인균수방지12개월，치료조중반복호흡도감염적발병인수위0례，이대조조위1례，량자비교차이유현저성의의(P<0.05)。결과표명자체제혈간세포이식유리우개선궤체세포면역공능，감만IgG하강수평，감소호흡궤적사용솔，축단주원시간，감저소영인적반복호흡도감염적발병솔。
BACKGROUND:The umbilical cord blood is rich in hematopoietic stem/progenitor cel s that have strong proliferation and differentiation ability as wel as ability to form colonies, and exert important roles in stimulating bone marrow function, improving blood cel viability and quantity, promoting immune cel maturation, and maintaining immune balance. OBJECTIVE:To evaluate the clinical effects of autologous umbilical cord blood mononuclear cel transplantation on the immunologic function and prognosis for premature infants. METHODS:Sixty-two preterm infants who entered into NICU immediately after birth, weighing ≤ 1 500 g, were divided into treatment group and control group according to parent’s wil ingness. In the treatment group, the umbilical cord blood was extracted from the umbilical vein and re-infused into the preterm infants after density gradient centrifugation within 4 hours. The cel ular immunity levels, humoral immunity levels and clinical parameters were monitored before and after treatment. RESULTS AND CONCLUSION:After 1 week of treatment, the CD4, CD4/CD8 levels were significantly increased compared with the control group (P=0.01, 0.03), but CD8 level had no changes. At 1 week after treatment, IgM levels were both increased in the two groups, especial y in the control group (P=0.00);IgA levels had no changes;IgG levels were decreased, especial y in the control group (P=0.02). The incidence of severe infection during hospitalization was 13%in the treatment group, which was lower than the control group (16%), but there was no difference between the two groups. The proportion of infants undergoing mechanical ventilation and average length of stay had significant differences between the two groups (P<0.05). After 12 months, the incidence of recurrent respiratory tract infections was zero in the treatment group and one case in the control group, and there was a significant difference between the two groups. These findings indicate that autologous umbilical cord blood mononuclear cel transplantation can improve the immunologic function, slower the reduction of IgG levels, reduce the usage of breathing machine, shorten the length of stay, and reduce the incidence of recurrent respiratory tract infections in preterm infants.