恶性血液病造血干细胞移植后感染病原菌分布及对BCL-2、BAX蛋白表达的影响

Distribution of Pathogenic Bacteria and Its Influence on Expression of BCL-2 and BAX Prote in after HSCT in the Patients with He matological Malignancies

目的:探讨恶性血液病患者外周血造血干细胞移植术后感染病原菌分布及对BCL-2、BAX蛋白表达的影响。方法:对2011年1月-2015年12月在弋矶山医院及省立医院血液科行造血干细胞移植的64例恶性血液病患者的临床资料进行分析,按照术后是否感染分为感染组(36例)和非感染组(28例),对造血干细胞移植后感染病原菌进行菌型鉴定,并对两组患者外周血T淋巴细胞亚群、C-反应蛋白(C-reaction protein,CRP)水平及血清细胞凋亡蛋白表达进行测定。结果:36例恶性血液病患者经造血干细胞移植后,从感染患者分离出病原菌共36株,其中革兰阴性菌24株(66.67%)且以肺炎克雷伯杆菌(19.44%)为主,感染组患者外周血中CD4+水平(t=2.637,P<0.01)、CD4+/CD8+比值(t=8.223,P<0.01)、BCL-2蛋白表达(t=5.852,P<0.01)、BCL-2/BAX比值(t=14.56,P<0.01)均显著低于非感染组,而感染组CD8+表达(t=2.285,P<0.01)、CRP水平(t=39.71,P<0.01)和BAX蛋白表达水平均高于非感染组。Pearson相关性检验分析发现,感染组患者CD4+/CD8+比值与BCL-2/BAX比值呈正相关(r=0.341,P<0.05),血清CRP水平与BCL-2/BAX比值呈负相关(r=-0.362,P<0.05)。结论:恶性血液病患者外周血造血干细胞移植术后感染病原菌以革兰阴性菌为主,术后感染能够促进相关炎症因子和凋亡蛋白表达的上调,病原菌可能也参与细胞凋亡过程。

Objective: To investigate the distribution of pathogenic bacteria in the patients w ith hematologic malignancies received hematopoietic stem cell transplantation( HSCT) and its influence on the expression of BCL-2 and BAX proteins. Methods: The clinical data of 64 patients w ith malignant lymphoma( M L) received auto-HSCT from January2011 to December 2015 in our hospital w ere analyzed. On basis of post- treansplant infection,the patients w ere divided into infection group( 36 cases) and non-infection group( 28 cases). The distribution of pathogenic bacteria in 2 groups w as identified,the T lymphocyte subsets of peripheral blood,expression level of apoptotic proteins and C-reaction protein( CRP) in 2 group were detected. Results: Thirty- six strains of pathogenic bacteria were isolated from 36 case of hematological malignancy after HSCT,including 24 strains of Gram-negative bacteria( 66. 67%) w ith predominamce of klebsiella pneumoniae( 19. 44%). The periperal blood CD4+( t = 2. 637,P < 0. 01),CD4+/ CD8+ratio( t = 8. 223,P <0. 01),BCL-2 protein( t = 5. 852,P < 0. 05),BCL-2 / BAX ratio( t = 14. 56,P < 0. 01) in infection group w ere significantly low er than those in non-infection group,w hile CD8+( t = 2. 285,P = < 0. 01),CRP( t = 39. 71,P <0. 01),BAX level in infection group w ere higher than those in non-infection group. The pearson correcation analysis show ed that the CD4+/ CD8+ratio in infection group positively correlated w ith BCL-2 / BAX ratio( t = 0. 341,P < 0. 05),w hile serum CRP level in infection group negatively correlated w ith BCL-2 / BAX ratio( t =- 0. 362,P < 0. 05). Conclusion: The pathogenic bacteria infecting M L patients after HSCT w ere mainly Gram-negative bacteria.The post-transplant infection can promote the expression up-regulation of related inflammatory factors and apoptotic proteins. The pathogens may be involved in cell apoptisis that provides a new strategy to treat the hematologic malignancies.