炎症介质对白血病患者骨髓间充质干细胞移植的影响

Effect of inflammatory media on bone marrow mesenchymal stem cell transplantation in leukemia patients

目的探究相关促炎症因子对白血病患者进行骨髓间充质干细胞(bone marrow mesenchyma stem cells,BMSC)移植的转归和预后的影响。方法选取自2015年11月3日—2017年5月3日来浙江省人民医院接受治疗的白血病患者82例,采用完全随机设计,按随机数字表法将其随机分为A(常规支持治疗)、B(采用骨髓间充质干细胞移植)2组,各41例,采用ELISA实验分析治疗前后血清相关炎症因子INF-γ、IL-1、TNF-α、IL-6、IL-4和IL-12的变化以及B组患者治疗前后骨髓增生活力变化。结果 2组患者治疗后血清中IL-1、TNF-α显著低于治疗前,且A组患者治疗后2项指标显著高于B组,差异具有统计学意义(t=13.652,P<0.001);B组患者经治疗后INF-γ、IL-1、TNF-α、IL-6、IL-4和IL-12显著降低,且除IL-6外,均显著低于A组治疗后血清表达水平,差异具有统计学意义(t=12.247,P<0.001);B组患者治疗后骨髓增生程度为活跃的百分比显著高于治疗前(治疗后vs.治疗前:43.9%vs.24.4%),差异具有统计学意义(χ~2=6.276,P=0.022);治疗后骨髓增生程度为极度减低的百分比显著降低(治疗后vs.治疗前:19.5%vs.43.9%),差异具有统计学意义(χ~2=5.632,P=0.032)。结论骨髓间充质干细胞移植能够有效降低炎症反应,增强骨髓增生活力,改善造血环境,可以作为白血病备选辅助治疗措施。

Objective To investigate the effect of proinflammatory cytokines on the outcome and prognosis of bone marrow mesencbyma stem cells （BMSCs） transplantation in leukemia patients. Methods A total of 82 patients with leukemia who underwent treatment from our hospital from 3 November, 2015 to 3 May, 2017 were randomized to A （conventional supportive therapy） according to the random number table method. IL-1, IL-6, IL-4 and IL-12 were detected by ELISA before and after treatment, and the levels of IL-1, IL-1, IL-6, IL-6 and IL-12 were detected by ELISA And the changes of bone marrow hyperplasia before and after treatment in group B patients. Results The levels of IL-1 and TNF-α in the serum of the two groups were significantly lower than those in the control group （P 〈 0. 001 ）, and the difference was statistically significant （t = 13. 652, P 〈0.001 ）. IL-1, TNF-α, IL-6, IL-4 and IL-12 were significantly decreased in the B group after treatment, and the expression of IL-1 was significantly lower than that of IL-6 （t = 12. 247, P 〈0. 001 ）. The percentage of active myeloproliferation in group B was significantly higher than that before treatment （ before treatment vs. before treatment ： 43.9% vs. 2.4% ） , and the difference was significant （ X2 = 6. 276, P = 0. 022） ; the percentage of myeloproliferation was significantly reduced after treatment （ before treatment vs. 19.5% vs. 43.9% ） , the difference was statistically significant （ X2 = 5. 632, P = 0. 032 ）. Conclusion Bone marrow mesenchymal stem cell transplantation can effectively reduce the inflammatory response, enhance myeloproliferative activity, improve the hematopoietic environment, and can be used as an adjunctive treatment for leukemia.