供受体KIR和HLA—Cw基因与无关供体造血干细胞移植后巨细胞病毒激活的相关性

Relationship between CMV reactivation and KIR haplotype/HLA-Cw genotype in patients after unrelated-donor hematopoietic stem cell transplantation

目的探讨移植物非去T细胞的无关供体造血干细胞移植（HSCT）后患者巨细胞病毒（CMV）激活与供受体杀伤细胞免疫球蛋白样受体（KIR）和HLA—Cw基因的相关性。方法以2003年1月至2008年12月48例行无关供体HSCT患者为研究对象，采用PCR—SSP和PCR．SSOP方法检测供受体KIR基因单体型和HLA—Cw位点，免疫组化监测这些患者移植后CMV感染情况。结果供受体HLA—Cw相合33例，不合15例，CMV激活率分别为48．5％和66．7％，两组比较差异无统计学意义（x2=1．39，P=0．2375），供受体均属于HLA—C1组的有37例，均属于HLA—C2组11例，CMV激活率分别为64．9％和18．2％，两组比较差异有统计学意义（X2=18．13，P〈0．19001）。供体为KIR单体型A的移植有26例，供体为KIR单体型B的移植有22例，CMV激活率分别为57．7％和50．0％，两者比较差异无统计学意义（x2=0．28，P=0．5941）。供体激活性KIR基因小于、等于受体的激活性KIR基因的有34例，CMV激活率为70．6％，供体激活性KIR基因大于受体激活性KIR基因的有14例，CMV激活率为14．3％，两者比较差异有统计学意义（x2=12．44，P=0．0004）。结论在无关供体HSCT中受体和供体不同激活性KIR的数量和HLA—Cw位点差异可能与CMV激活存在相关性。

Objective To explore the relationship between CMV reactivation and KIR haplotype or HLA-Cw genotype in patients after unrelated-donor hematopoietic stem cell transplantation（HSCT）. Methods From January 2003 to December 2008 the HLA-Cw/KIR genotypc of 48 patient-donor pairs were determined by polymerase chain reaction with sequence specific primers （ PCR-SSP ） and sequence specific nucleotide （PCR-SSOP）. Posttransplant CMV reactivation was performed by immune histochemically assay. Re- suits Of 48 patients, 15 were transplanted from unrelated donors with an antigen mismatch for HLA Cw and 33 patient-donor pairs were matched for HLA-Cw. The CMV reaction rate was 66.7% for HLA-Cw mismatch group and 48.5% for HLA-Cw match group （ X2 = 1.39, P = 0.2375）. Thirty-seven donor-patients pairs belonged to group C1 and 11 to group C2, and CMV reaction rate was 64.9% in group C1 and 18.2% in group C2（X2 = 18.13, P 〈0. 0001 ）. Twenty-six patients received graft from KIR haplotype A （group A donor） and 22 from KIR haplotype B donors （ group B donor） and CMV reaction rate was 57.7% in group A donor and 50.0% in group B donor （ X2 = 0.28, P = 0.5941 ）. The number of donor activating KIRs （aKIRs） was less than that of recipient aKIRs in 34 patient-donor pairs in which the CMV reaction rate was 70.6% , and the number of donor aKIRs was more than that of recipient aKIRs in 14 patient-donor pairs in which the CMV reactivation was 14.3 %. There was a significan difference between the two group （X2 = 12.44, P = 0.0004 ）. Conclusion KIR and HLA-Cw genotypes influence the rate of CMV reactivation following non-T cell deleted unrelated donor hematopoietic cell transplantation.