脐带间充质干细胞静脉输注治疗难治性重型再生障碍性贫血疗效及对外周血Th1、Th17水平的影响

Therapeutic Effects of Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in the Treatment of Refractory Severe Aplastic Anemia and Its Influence on Peripheral Blood Th1 and Th17 Levels

目的探讨脐带间充质干细胞(MSC)静脉输注治疗难治性重型再生障碍性贫血(SAA)疗效及对外周血辅助性T细胞1(Th1)、辅助性T细胞17(Th17)水平的影响。方法选取2014年2月至2019年11月在本院接受治疗的重型再生障碍性贫血患者106例作为研究对象,检测患者治疗前、治疗1个月、2个月、3个月后外周血Th1、Th17水平、血象变化及不良反应,根据疗效将其分为预后良好组和预后不良组,采用单因素和多因素分析疗效与临床因素的关系。结果106例患者输注过程中及输注24 h内均未出现明显不良反应;治疗1年后预后随访,CR 31例(29.25%)、PR 44例(41.51%)、NR 19例(17.92%)、死亡12例(11.32%),即预后良好组75例,预后不良组31例;患者治疗1个月后外周血Th1、Th17水平无明显变化(P>0.05),治疗2个月、3个月后外周血Th1逐渐升高,Th17逐渐降低(P<0.05);治疗1个月、2个月、3个月后患者白细胞、中性粒细胞明显回升(P<0.05),治疗1个月时血小板、血红蛋白回升缓慢(P>0.05),治疗2个月、3个月后逐渐回升(P<0.05);Pearson相关性分析显示,患者治疗前后外周血Th1与白细胞、中性粒细胞、血小板、血红蛋白水平正相关,Th17水平与白细胞、中性粒细胞、血小板、血红蛋白水平负相关(P<0.05)。经单因素和多因素分析显示,患者合并感染情况、诊断到治疗时间及治疗前Th1、Th17水平是影响患者预后的独立危险因素(P<0.05)。结论MSC治疗SAA患者疗效较好,安全性较高,有助于SAA患者体内Th1/Th17的免疫平衡,且Th1、Th17水平改善与血象恢复密切相关,也是影响预后的重要因素。

Objective To study the therapeutic effects of intravenous infusion of umbilical cord mesenchymal stem cells(MSC)in the treatment of refractory severe aplastic anemia(SAA)and the influence on peripheral blood T helper 1(Th1)and T helper 17(Th17)levels.Methods Between February,2014 and November,2019,106 patients with SAA were selected as study subjects.Changes of peripheral blood Th1 and Th17 levels,hemogram before treatment,after 1 month,2 months and 3 months of treatment,and adverse reactions were observed.According to the curative effect,the patients were divided into the good prognosis group and poor prognosis group.Univariate and multivariate analyses of the relationship between curative effect and clinical factors were performed.Results No significant adverse reactions were observed during infusion and within 24 hours.1 year after treatment,there were 31 cases of CR(29.25%),44 cases of PR(41.51%),19 cases of NR(17.92%)and 12 deaths(11.32%),namely,75 cases had a good prognosis and 31 cases had a poor prognosis.No significant changes in peripheral blood Th1 and Th17 levels were observed after 1 month of treatment(P>0.05).The peripheral blood Th1 increased,while Th17 decreased after 2 months and 3 months of treatment(P<0.05)After 1 month,2 months and 3 months of treatment,white blood cells and neutrophils increased significantly(P<0.05).Platelets and hemoglobin increased slowly after 1 month of treatment(P>0.05),and gradually recovered after 2 months and 3 months of treatment(P<0.05).Pearson correlation analysis showed that peripheral blood Th1 level was positively correlated with the levels of white blood cells,neutrophils,platelets,and hemoglobin before and after treatment,while Th17 level was negatively correlated with the levels of white blood cells,neutrophils,platelets and hemoglobin(P<0.05).Univariate and multivariate analyses showed that co-infection,time to treatment,peripheral blood Th1 and Th17 levels before treatment were independent risk factors affecting the prognosis of patients(P<0.05).Conclusion MSC treatment is effective for patients with SAA,with a relative higher safety.It is conducive to Th1/Th17 balance in patients with SAA.Furthermore,the improvement of Th1 and Th17 levels is closely related to hemogram recovery,which are also important prognostic factors.