慢性移植物抗宿主病的研究与进展

Research progress in chronic graft versus host disease

学术背景:在同种异体移植物中存在的成熟αβT细胞不仅能重建受者体内的T细胞免疫,而且能清除受者体内的恶性细胞。但是,这些T细胞识别受体作为"非己",并且发动广泛的免疫机制攻击受体组织,即移植物抗宿主病。目的:总结慢性移植物抗宿主病的研究与进展。检索策略:由该论文的研究人员应用计算机检索PubMed数据库2000-01/2007-09期间的相关文献,检索词"HSCT,chronic GVHD,immunologicsuppression",并限定文章语言种类为English。对资料进行初审,并查看每篇文献后的引文。纳入标准:①与慢性移植物抗宿主病的基础研究和临床治疗密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准:重复性研究。共收集到65篇相关文献,40篇文献符合纳入标准,排除的25篇为内容陈旧或重复文献。文献评价:文献的来源主要是慢性移植物抗宿主病的研究方面的随机对照试验。所选用的40篇文献中,7篇为综述,其余均为临床或基础实验研究。资料综合:慢性移植物抗宿主病是同种异体造血干细胞移植主要的并发症。慢性移植物抗宿主病的临床表现错综复杂,并且发病病理生理过程仍未研究清楚。尽管对慢性移植物抗宿主病治疗中细胞因子的改变、能够清除产生自身抗体的B细胞单克隆抗体以及其他免疫调节药物所起的作用正在研究过程中,但由于慢性移植物抗宿主病受累器官的多样性、疾病的慢性病程以及血液学和免疫学的功能异常,其发生率及死亡率并没有改变。结论:要更加深入理解慢性移植物抗宿主病的发病机制,进一步的小鼠模型研究以及相关的临床研究势在必行。

BACKGROUND： The mature α β T cells exist in allograft cannot only rebuilt the immunologic ability of T cells in the recipient body but also cleanse the malignant cells as well. However, those T cells recognizing recipient as ＂non-self＂ at the same time can attach the body via immunologic mechanism on a large scale, or graft verse host disease in general. OBJECTIVE： To summarize the recent progression of chronic graft versus host disease. RETRIEVAL STRATEGY： A computer based search was conducted in Pubmed database for literatures published from January 2000 to September 2007 with the key words of ＂HSCT, chronic GVHD, immunologic suppression＂ in English. The data were primarily checked, and quotations of each article were checked out. Inclusive criteria included （1）basic research and clinical treatment of chronic graft versus host disease, （2）on the same circle, articles recently published or in authoritative journals. Exclusive criteria included repetitive research. A total of 65 literatures were selected and 40 articles met the inclusive criteria. The excluded 25 articles were with old content or repetitive articles. LITERATURE EVALUATION： Most of them come directly from basic research and randomized controlled trial of chronic graft versus host disease. Forty of them met our selective criterion, and 7 of them were review and 40 of them were clinical or original research. DATA SYNTHESIS： Chronic graft versus host disease is the major complication of allogenic haemopoietic stem cell transplantation. Clinical manifestation of chronic graft versus host disease is complicated, and the pathophysiology of onset is still unclear. The change of cytokines and the immunologic antibodes together with the corresponding therapy are under research, but the incidence and mortality of chronic graft versus host disease does not change, because of the diversity of involving organs in chronic graft versus host disease, chronic process and disfunction of hematology and immunology. CONCLUSION： It is necessary to do further researches on rat models and relevant clinical researches for further studying the pathogenesy of chronic graft versus host disease.