不同预处理方案自体非清髓性造血干细胞移植治疗系统性红斑狼疮的临床观察

Clinical report on nonmyeloablative autologous peripheral blood stem cell transplantation for systemiclupus erythematosus by using different conditioning regimens

目的比较2种不同预处理方案行非清髓性自体外周血造血干细胞移植（NAST）治疗系统性红斑狼疮（SLE）的疗效及安全性。方法组一为阿糖胞苷（200mg·kg^-1·d^-1，-2--1d）＋环磷酰胺（40mg·kg^-1·d^-1，-2--1d）。组二为抗胸腺细胞球蛋白（30mg·kg^-1·d^-1·，-5--3d）＋环磷酰胺（40mg·kg^-1·d^-1，-2--1d）。评价患者移植前后免疫指标的变化、造血重建的情况及并发症。应用配对t检验，比较2组的白细胞、中性粒细胞、血小板恢复的时间。结果8例患者均成功植入。组一和组二各4例外周血白细胞〉10×10^9]L、中性粒细胞〉0．5×10^9／L、血小板〉100×10^9／L及血红蛋白〉120g／L的平均时间分别为[（7．2±1．3）、（8．0±1．5）、（10．5±12．4）、（22．1±2．3）d]和[（10．4±2．1）、（12．0±1．9）、（19．3±2．1）、（28．1±2．4）d]，差异有统计学意义（氏0．02）。6例抗核抗体、抗双链DNA（dsDNA）抗体于移植后30。90d转阴，余2例分别于15个月和18个月后转阴。移植前明显降低的CD4＋及CD4＋／CD8＋比值移植后逐渐恢复正常，2组差异无统计学意义。结论从免疫重建来看，是否使用ATG并没有明显差别。从安全性及造血重建考虑，我们推荐用阿糖胞苷＋环磷酰胺替代含有ATG的方案进行预处理。

Objective To compare the clinical efficacy and safety of two different conditioning regimens in nonmyeloablative autologous peripheral blood stern cell transplantation （NAST） for the treatment of systemic lupus erythematosus （SLE）. Methods Different conditioning regimens were used in two groups： cytarabin combined cyclophosphamide in group 1 and ATG combined cyclophosphamide in group 2. Different recovery time of leucocytes, neutrophils and platelets in the two groups were compared. Statistical analysis were carried out by paired t-test. Results The mean time for peripheral leucocytes reaching 1.0×10……9/L, neutrophils getting up to 0.5×10^9/L, platelet raising to 100×10^9/L and hemoglobin rising to 120 g/L in group 1 were [（7.2＋1.3）, （8.0±1.5）, （10.5±1.4）, （22.1±2.3）days] and [（10.4±2.1）, （12.0±1.9）, （19.3±2.1）, （28.1± 2.4） ] days in group 2. The difference was statistically significant （P〈0.01）. （P〈0.01） cell count and the ratio of CD4＋/CD8＋ of pre- and pro-NAST was changed. No significant differences were observed in the two groups. Conclusion For the sake of safety and hematopoietic reconstitution, we recommend cytarabin combined cvclophosphamide as the preferred conditioning regimen.