Th17/Treg比值变化在异基因造血干细胞移植后急性GVHD发生中的意义

Significance of Th17/Treg Ratio in aGVHD Occurence after Allo-HSCT

目的:探讨异基因造血干细胞移植后患者外周血中Th17/Treg细胞水平的变化与急性移植物抗宿主病(aGVHD)发生的关系。方法:39例行异基因造血干细胞移植的患者分为2组:aGVHD组17例,采集aGVHD发生前、发生时及好转后的外周血;无GVHD组22例,采集移植后1、2和3个月时外周血;另16例健康供者于动员前采集外周血。应用流式细胞术分别检测外周血中Th17细胞及Treg细胞的数值,计算Th17/Treg比值。结果:移植后发生aGVHD的患者中在发生aGVHD前,与未发生aGVHD的患者相比,Th17细胞水平升高和Treg细胞数降低,Th17/Treg比值升高(P<0.05);发生aGVHD后,与发生aGVHD之前比较,Th17细胞数降低,Treg细胞水平升高,Th17/Treg比值降低(P<0.05);aGVHD好转后,Th17/Treg比值与正常人比较,无统计学差异(P>0.05)。移植后无aGVHD的患者中,2和3个月Th17/Treg比值与正常人比较,无统计学差异(P>0.05)。结论:移植后患者Th17细胞及Treg细胞水平恢复缓慢,但Th17/Treg比值约在2月后恢复。Th17细胞可能启动aGVHD的发生,aGVHD发生后,Treg细胞水平升高,并可能通过抑制Th17细胞来调控aGVHD的转归。移植后检测Th17/Treg比值变化可预测aGVHD的发生、转归。

Objective：To explore the relationship between Th17 and Treg levels and aGVHD occurence in patients after allo-HSCT. Methods： Thirtynine patients received allo-HSCT were divided into 2 groups： aGVHD group （17 cases） and non-aGVHD group （22 cases ）. For aGVHD group, the peripheral blood was collected before aGVHD occurence, in occurence and after aGVHD improvement; for non-aGVHD group, the peripheral blood was collected after 1,2 and 3 months of transplantation. In addition, 16 healthy donors were used as controls, their peripheral blood was collected before mobilization. The Th17 and Treg counts as well as Th17/Treg ratio were detected by flow cytometry. Results ： Among patients with aGVHD after transplantation, the Th17 count increased, and the Treg count decreased, the Th17/Treg ratio increased before aGVHD occurence, as compared with the patients without aGVHD （ P 〈 0.05 ） ; but after aGVHD occurence, the Th17 count decreased, Treg count increated, and the Th17/Treg ratio decreased as compared with that before aGVHD occurence （P 〈 0.05 ）. After aGVHD was improved, the Th17/Treg ratio decreased as compared with level before aGVHD occurence （P 〈 0.05 ）. After aGVHD was improved, the Th17/Treg ratio was no statistical different from healthy donors （ P 〉 0.05 ）. Among patients without aGVHD after transplantation, the Th17/ Treg ratio at 2 and 3 months after transplantation was no statistical different from that of healthy donos （ P 〉 0.05 ）. Conclusion：The Th17 and Treg levels recoverel showly after transplantation, but the Th17/Treg ratio recoveres after 2 months in the patients after transplantation. The Th17 ceils may initiate aGVHD; when aGVHD happened, the Treg level increases, which may regulate the aGVHD ontcome through inhibiting the Th17 cells. The detection of Th17/Treg ratio after transplantation can predict the occurence and outcome of aGVHD.