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中华细胞与干细胞杂志(电子版) ›› 2019, Vol. 09 ›› Issue (02) : 102 -106. doi: 10.3877/cma.j.issn.2095-1221.2019.02.006

论著

T细胞、BCL-2、BAX对重型再生障碍性贫血患者异基因造血干细胞移植术后感染的临床意义分析
张彦1, 万佳2,()   
  1. 1. 400038 重庆,西南医院重症医学科
    2. 400038 重庆,西南医院血液科
  • 收稿日期:2019-01-12 出版日期:2019-04-01
  • 通信作者: 万佳

Significance of T cell, BCL-2 and BAX levels in patients with severe aplastic anemia after allogeneic hematopoietic stem cell transplantation

Yan Zhang1, Jia Wan2,()   

  1. 1. Department of Critical Care Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing 400038, China
    2. Department of Hematology, the First Affiliated Hospital of the Army Military Medical University, Chongqing 400038, China
  • Received:2019-01-12 Published:2019-04-01
  • Corresponding author: Jia Wan
引用本文:

张彦, 万佳. T细胞、BCL-2、BAX对重型再生障碍性贫血患者异基因造血干细胞移植术后感染的临床意义分析[J]. 中华细胞与干细胞杂志(电子版), 2019, 09(02): 102-106.

Yan Zhang, Jia Wan. Significance of T cell, BCL-2 and BAX levels in patients with severe aplastic anemia after allogeneic hematopoietic stem cell transplantation[J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2019, 09(02): 102-106.

目的

探讨T细胞计数、BCL-2、BAX水平在重型再生障碍性贫血患者异基因造血干细胞移植术后感染的意义。

方法

选择2014年1月至2018年1月西南医院收治的52例重型再生障碍性贫血异基因造血干细胞移植患者作为研究对象,依据干细胞移植后是否发生感染分为未发生感染组(32例)、感染组(20例)。采用流式细胞仪检测入组者外周血T淋巴细胞总数(CD3+)、T辅助/诱导细胞亚群(CD4+)、T抑制/毒性细胞亚群(CD8+),以及T辅助细胞/ T抑制细胞比值(CD4+/CD8+);采用酶联免疫吸附试验检测BCL-2、BAX蛋白表达情况;并对两组患者随访1年,记录两组患者生存情况。符合正态分布资料采用t检验,非正态分布资料采用秩和检验。

结果

未感染组患者外周血CD3+(79.09±15.40)个/μl、CD4+(128.78±24.36)个/ μl、CD4+/CD8+(1.68±0.15)个/μl高于感染组CD3+(57.62±10.36)个/μl、CD4+(86.17±11.22)个/ μl、CD4+/ CD8+(1.15±0.10)个/μl,未感染组CD8+(74.17±5.48)个/μl低于感染组CD8+(76.79±4.36)个/μl,差异具有统计学意义(P均< 0.05)。未感染组患者外周血蛋白水平BCL-2(0.48±0.10)、BCL-2/BAX(1.07±0.06)高于感染组BCL-2(0.34±0.07)及BCL-2/BAX(0.83±0.04),未感染组蛋白水平BAX(0.33±0.04)低于感染组BAX(0.41±0.12),差异具有统计学意义(P < 0.05)。Pearson相关性检验分析发现重型再生障碍性贫血患者异基因造血干细胞移植后CD4+/CD8+值与BCL-2/BAX值呈现正相关(r = 0.620,P < 0.01)。非感染组患者1年生存率为90.63%(29/32),感染组患者1年生存率为50.00%(10/20),两组患者生存率比较差异具有统计学意义(χ2= 6.2184,P < 0.01)。

结论

重型再生障碍性贫血异基因造血干细胞移植术后发生感染,加重免疫功能异常,可能与细胞凋亡蛋白BCL-2表达上调有关,且干细胞移植术后发生感染显著缩短患者生存期。

Objective

To investigate the expression and significance of T cell count, BCL- 2 and BAX protein in patients with severe aplastic anemia after allogeneic hematopoietic stem cell transplantation.

Methods

From January 2014 to January 2018, 52 patients with severe aplastic anemia treated by allogeneic hematopoietic stem cell transplantation in our hospital were selected as the research objects. According to whether infection occurred after stem cell transplantation, they were divided into a non-infection group (32 cases) and an infected group (20 cases). The peripheral blood total T lymphocyte count (CD3+), T-helper/induced cell subsets (CD4+), T-suppressor/ toxic cell subsets (CD8+) and T-helper/T-suppressor cell ratio (CD4+/ CD8+) were detected by flow cytometry. The expression of BCL-2 and BAX protein was detected by enzyme- linked immunosorbent assay (ELISA). Two groups of patients were followed up for one year, and the survival of the two groups was recorded.

Results

The levels of CD3+ (79.09±15.40), CD4+ (128.78±24.36), CD4+/ CD8+ (1.68±0.15) in the non-infected group were higher than those in the infected group CD3+ (57.62±10.36), CD4+ (86.17±11.22), CD4+/CD8+ (1.15±0.10). The levels of CD8+ (74.17±5.48) in the non-infected group were lower than those in the infected group (76.79±4.36). The difference was statistically significant (P < 0.05). The levels of BCL- 2 (0.48±0.10) eggs and BCL-2/BAX (1.07±0.06) in the non-infected group were higher than those in the infected group (0.34±0.07) eggs and BCL-2/BAX (0.83+0.04). The level of BAX (0.33±0.04) in the non-infected group was lower than that in the infected group (0.41±0.12). The difference was statistically significant (P < 0.05). Pearson correlation test showed that CD4+/ CD8+ was positively correlated with BCL-2/ BAX in patients with severe aplastic anemia after allogeneic hematopoietic stem cell transplantation (r = 0.620, P < 0.001). The 1-year survival rate of the non- infected group was 90.63% (29/32) and that of the infected group was 50.00% (10/20). There was significant difference between the two groups (χ2 = 6.2184, P = 0.0064) .

Conclusion

Infection after allogeneic hematopoietic stem cell transplantation in severe aplastic anemia may lead to abnormal immune function, which may be related to the up-regulation of apoptotic protein BCL-2 expression. Infection after stem cell transplantation significantly shortens the survival time of patients.

表1 再生障碍性贫血患者的一般资料
表2 两组SAA患者外周血T细胞亚群检测情况( ± s,个/μl)
表3 两组SAA患者BCL-2、BAX蛋白表达情况( ± s
图1 重型再生障碍性贫血CD4+/CD8+值与BCL-2/BAX值的相关性
图2 两组患者1年随访生存情况
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