重症联合免疫缺陷病新生儿筛查及免疫系统重建研究进展

Advances in newborn screening and immune system reconstitution of severe combined immunodeficiency

重症联合免疫缺陷病是一组罕见的先天性疾病,特征为T淋巴细胞数量和(或)功能严重缺陷,临床可表现为反复、持续、严重的感染。新生儿筛查及免疫系统重建是影响重症联合免疫缺陷病患儿临床预后的关键。基于外周血干血斑T细胞受体切除环定量检测技术的新生儿筛查项目已在临床开展,但存在一定的局限性,其他新的方法如串联质谱分析、T淋巴细胞特异性生物标志物测定等正处于研究阶段。造血干细胞移植和基因治疗是现阶段重建患儿免疫功能的主要方法。各中心致力于提高移植成功率及病毒载体长期安全性、稳定性的研究已取得一定成果,但远期疗效仍需更多大规模的前瞻性临床研究来评估。本文对重症联合免疫缺陷病新生儿筛查及免疫系统重建的研究进展作一综述。

Severe combined immunodeficiency disease (SCID) is a group of rare congenital diseases characterized by severe deficiencies in T lymphocyte counts and/or function. The recurrent, persistent and severe infections are its clinical manifestations. Neonatal screening and immune system reconstruction would improve the prognosis of SCID children. Newborn screening programs based on T-cell receptor excision circles (TRECs) quantitative detection have been carried out in clinical practice, however, the methods still have some limitations. Other new methods such as mass spectrometry and T lymphocyte-specific biomarker assays are still under investigation. Hematopoietic stem cell transplantation and gene therapy are the two main methods for reconstructing immune function in SCID children. Through improving the success rate of transplantation and the long-term safety and stability of viral vectors, some achievements have been made by many centers already. However, large-scale prospective studies are needed for evaluation of the long-term efficacy. In this article, the recent progress in newborn screening and immune reconstitution of SCID is reviewed.