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目的:探讨微颗粒(microparticles,MP)在异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)过程中的改变及其临床意义,寻找移植后血栓性并发症的早期诊断指标。方法:对我院94例allo-HSCT患者,根据移植后首先出现的并发症情况分为4组:急性移植物抗宿主病(acute graft versus host disease,a GVHD)组27例(Ⅱ度以上10例)、血栓组9例、感染组41例和平稳组17例。采集患者移植预处理前(-10d)、预处理结束(0 d)、造血干细胞回输后(+10 d,+20 d)4个不同时间段的血浆标本,以流式细胞术检测组织因子微颗粒(tissue factor positive microparticles,TF+M P)和内皮细胞微颗粒(endothelial microparticles,EM P)水平,动态观察TF+M P和EM P在allo-HSCT过程中的变化及意义。回顾性分析这两种微颗粒指标与预处理、移植后血栓病变、a GVHD及感染之间的关系。结果:1 all-HSCT患者预处理前TF+M P和EM P水平分别较正常对照组明显升高(P<0.01),随后在各个时间段虽然呈现不同的波动,但没有明显的统计学差异(P>0.05)。虽然TF+M P和EM P水平在预处理结束较预处理前有所升高,但是并不存在统计学差异。2 TF+M P和EM P水平在血栓组中升高明显,升高水平大于a GVHD组和感染组(P<0.05)。3血栓组中的TF+M P和EM P水平在各个时间段与其他观察组相比均有明显差异(P<0.05),而a GVHD组与感染组中的TF+M P和EM P水平较平稳组无明显差异(P>0.05)。结论:血浆TF+M P和EM P水平的增高可能与移植后相关血栓病变有关,提示肝静脉闭塞病(HVOD)等血栓并发症的发生。因此,动态监测TF+M P和EM P水平有望预测血栓性病变的发生,为移植后血栓性疾病的诊断提供帮助。
OBJECTIVE: To investigate the changes and clinical significance of microparticles (MP) in allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to find out the early diagnostic indexes of thrombotic complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A total of 94 patients with allo-HSCT in our hospital were divided into 4 groups according to the first complication after transplantation: 27 cases of acute graft versus host disease (a GVHD) Cases), thrombus group 9 cases, infection group 41 cases and stable group 17 cases. Plasma samples were collected before transplantation (-10 d), pretreatment (0 d), hematopoietic stem cell transplantation (+10 d, +20 d) at 4 different time points after transplantation. Flow cytometry was used to detect tissue factor The changes of TF + MP and EM P in allo-HSCT and their significance were observed dynamically by measuring the levels of tissue factor positive microparticles (TF + MP) and endothelial microparticles (EM microparticles). The relationship between these two microparticle indexes and pretreatment, thrombosis after transplantation, a-GVHD and infection was retrospectively analyzed. Results: The levels of TF + MP and EM P before treatment in all-HSCT patients were significantly higher than those in the normal control group (P <0.01), and then there was no significant difference between the two groups P> 0.05). Although the levels of TF + M P and EM P increased at the end of pretreatment compared to pretreatment, there was no statistical difference. The levels of TF + M P and EM P in thrombosis group were significantly higher than those in aGVHD group and infection group (P <0.05). 3 The level of TF + MP and EM P in thrombosis group were significantly different from other observation groups at various time points (P <0.05), while the levels of TF + MP and EM P in aGVHD group and infection group were stable Group no significant difference (P> 0.05). Conclusion: The increase of plasma TF + M P and EM P levels may be related to thrombosis after transplantation, suggesting the occurrence of thromboembolic complications such as hepatic veno-occlusive disease (HVOD). Therefore, the dynamic monitoring of TF + M P and EM P levels is expected to predict the occurrence of thrombotic lesions, which may be helpful in the diagnosis of post-transplant thrombotic diseases.