可溶性白细胞介素-2受体、CD_(25)^+细胞与急性移植物抗宿主病关系的研究

A study on the relations of soluble interleukin-2 receptor and CD_(25)^+ cell with acute graft-versus-host disease

目的 研究造血干细胞移植期（ＨＳＣＴ）细胞因子及受体水平的变化、免疫重建与急性移植物抗宿主病（ａＧＶＨＤ）的关系，以探讨临床预测ａＧＶＨＤ的指标。方法 ２２例ＨＳＣＴ患者，采用双夹心ＥＬＩＳＡ动态监测血清细胞因子及受体白细胞介素－６、白细胞介素－８、干扰素－γ、肿瘤坏死因子－ａ、可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）水平的变化、流式细胞仪检测移植后淋巴细胞亚群ＣＤ３＋、ＣＤ４＋、ＣＤ８＋、ＣＤ２５＋、ＣＤ６９＋细胞的重建。结果 ２２例患者均获得造血重建，６例发生Ｉ度ＧＶＨＤ，４例发生Ⅲ－Ⅳ度ＧＨＶＤ。ｓＩＬ－２Ｒ在ａＧＶＨＤ发生组于移植后第２周上升，第３周达峰值，Ⅲ－Ⅳ度ＧＶＨＤ峰值为（４２０．３±５９．８）Ｕ／Ｌ，Ｉ度ＧＶＨＤ峰值为（２２１．５±３８．８）Ｕ／Ｌ，早于ａＧＶＨＤ的症状出现，与疾病的严重程度显著相关，随症状的缓解而下降。其他细胞因子水平的变化与ａＧＶＨＤ的发生无明显关系。ＣＤ２５＋细胞的升高与ｓＩＬ－２Ｒ一致。结论分析移植后患者血清细胞因子水平的变化及免疫重建可以预测ａＧＶＨＤ的发生，ｓＩＬ－２Ｒ、ＣＤ２５＋细胞在ａＧＶＨＤ发生之前明显上升，是预测ａＧＶＨＤ的指标。

Objective: Acute graft-versus-host disease (aGVHD) is one of the major complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Prediction of human aGVHD may be of help in its diagnosis and therapy. Methods 22 patients undergoing HSCT were included in this study. After transplantation, serum concentrations of interlukin-6. interlukin-8. tumor necrosis factor-a, interforon-γ and sIL-2R were measured periordically by using enzymed-linked immunosorbent assay. Immune reconstitution of CD3+ .CD4+ .CD8+ .CD25+ and CD69+ cells were analyzed with flow cytometry. Results All the patients achieved engraftment. 6 patients developed grade I GVHD and 4 patients deveolped grade Ⅲ-Ⅳ GAHD. Patients with aGVHD demonstrated significantly higher sIL-2R levels than those without. The peak levels of grade Ⅲ-Ⅳ ＧＶＨＤ were(４２０.3 ± 59.8) U/L,and the peak levels of grade I GVHD were (221.5 ± 38.8)U/L. The increase of sIL-2R level in serum preceded the clinical signs of aGVHD .The maximum levels of sIL-2R correlated significantly with the seventy of aGVHD.The increase of CD25+ cells was in acordance with that of sIL-2R. Conclusions Analysis of serum cytokines and immune reconstitution after HSCT may provide predictive value for aGVHD.