重型再生障碍性贫血患者免疫抑制治疗后骨髓造血祖细胞水平的变化及其意义

Changes of Marrow Hematopoietic Progenitor Cells in Patients with Severe Aplastic Anemia after Intensive Immunosuppressive Therapy

为更好地评价重型再生障碍性贫血(SAA)患者免疫抑制治疗(IST)后骨髓造血功能恢复程度,采用造血祖细胞体外培养技术,动态观察了48例接受IBT的SAA患者及20例正常对照者骨髓晚期红系爆式集落形成单位(mBFU-E)及粒-巨噬系集落形成单位(CFU-GM)的水平变化。结果表明,IST前所有SAA患者骨髓mBFU-E及CFU-GM水平均显著低于正常对照组(P<0.001);IST后1年,29例有效者骨髓mBFU-E及CFU-GM水平显著增高,增高程度与其临床疗效相关;12例mBFU-E及10例CFU-GM水平恢复正常,其中8例患者mBFU-E及CFU-GM水平同时恢复正常。这表明SAA确是一组异质性疾病,其造血功能衰竭与异常免疫关系密切,若去除这种异常,造血功能可获得部分甚至完全重建。

To evaluate more precisely the degree of bone marrow hematopoietic function recovery in patients with severe aplastic anemia (SAA) after intensive immunosuppressive therapy (IST), changes of bone marrow hematopoietic progenitor cells, including late burst-forming unit-erythroid (mBFU-E) and colony forming unit-granulocyte/macrophage (CFU-GM), of patients with SAA after 1ST were observed by using the technique of semisolid culture in vitro. The results showed that the levels of mBFU-E and CFU-GM decreased significantly for all patients before IST as compared with the normal controls (P<0.001); after IST, 29 responding patients showed significant enhancement of mBFU-E and CFU-GM, which were correlated well with their clinical responses; the mBFU-E levels in 12 patients and CFU-GM levels in 10 patients recovered to normal, and both mBFU-E and CFU-GM levels in 8 patients recovered to normal simultaneously. These results indicate that SAA is pathologically heterogenous and particularly related to abnormal immunity and that once the abnormal immunity suppressed, SAA patients may get complete or partial recovery of hematopoiesis.