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目的 :观察多种免疫抑制剂联合使用后半相合未去T细胞骨髓移植术后患者免疫功能的恢复情况。方法 :38例白血病患者接受HLA 2～ 3个位点不匹配的亲缘骨髓移植 ,用ATG、CD2 5抗体、CSA、MTX、MMF预防移植物抗宿主病 (GVHD) ,定期对受者在移植术后 1、3、6、12、18个月的外周血淋巴细胞亚群和血清免疫球蛋白进行检测。结果 :移植术后 1个月患者淋巴细胞各亚群均明显下降 ,CD4 + T最明显 ,CD4 + T细胞绝对数在 +6月达 2 0 0个 /μl,导致CD4 /CD8持续倒置 ,在移植后 18个月才逐渐恢复。CD3+ 、CD8+ 、CD19+ B细胞计数在BMT后的 6～ 12个月基本恢复。因常规输注丙种球蛋白BMT后IgG一直正常 ,IgM和IgA分别在移植后 6～ 9个月和 18个月恢复。结论 :单倍体相合骨髓移植后 1年患者免疫功能处于低下状态 ,CD4 + T和IgA恢复最慢 ,CD4 + 细胞百分比和绝对值持续的低下 ,CD4 /CD8持续倒置是移植后感染高发的原因 ,该期间要适当应用免疫支持治疗及环境保护
OBJECTIVE: To observe the recovery of immune function in patients with combined immunosuppressive agents after semi-concomitant unseeded T-cell bone marrow transplantation. METHODS: Thirty-eight leukemia patients underwent HLA-B mismatch-related HLA transplantation. ATG, CD2 5, CSA, MTX, and MMF were used to prevent graft-versus-host disease (GVHD) After 1, 3, 6, 12, 18 months of peripheral blood lymphocyte subsets and serum immunoglobulin were detected. Results: At 1 month after transplantation, the subpopulations of lymphocytes were significantly decreased, CD4 + T was the most obvious, and the absolute number of CD4 + T cells was up to 200 / μl in + June, resulting in persistent inversion of CD4 / CD8. 18 months after transplantation gradually recovered. The counts of CD3 +, CD8 + and CD19 + B cells recovered basically from 6 to 12 months after BMT. IgG was normal after conventional administration of gamma globulin BMT, IgM and IgA recovered at 6-9 months and 18 months after transplantation, respectively. CONCLUSIONS: One year after haploidentical bone marrow transplantation, immunocompromised patients were in a low immune state with the slowest recovery of CD4 + T and IgA, the persistently low percentage of CD4 + cells and persistent CD4 / CD8 persistence During this period, we should appropriately apply immunosuppressive therapy and environmental protection