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目的 探讨自体外周血干细胞移植 (APBSCT)及CD34+ 细胞分选治疗难治性类风湿关节炎 (RA)的疗效、安全性及移植后免疫重建过程。方法 对 1例RA患者进行APBSCT及CD34+ 细胞分选治疗 ,干细胞动员方案为环磷酰胺 (CY)及粒细胞集落刺激因子 (G CSF) ,将采集物进行CD34+ 细胞分选 ,- 80℃冰箱冻存。经CY与抗胸腺免疫球蛋白 (ATG)预处理后进行干细胞回输 ,并应用G CSF协助造血重建 ,移植后观察临床表现及实验室指标的变化。移植前后进行淋巴细胞表型分析 ,监测免疫重建过程。结果 对患者成功地施行了动员及预处理方案 ,干细胞回输反应良好。移植后随访 12个月 ,患者关节肿痛完全消失 ,生活质量明显改善 ,血沉、C 反应蛋白降至正常 ,类风湿因子转阴 ;免疫重建过程正在进行。结论 APBSCT并CD34+ 细胞分选治疗RA安全性好 ,中短期疗效显著 ,移植后免疫重建过程尚需进一步随访观察
Objective To investigate the efficacy and safety of autologous peripheral blood stem cell transplantation (APBSCT) and CD34 + cell sorting in the treatment of refractory rheumatoid arthritis (RA) and the immune reconstruction after transplantation. Methods One RA patient was treated with APBSCT and CD34 + cells. The stem cell mobilization protocol was cyclophosphamide (CY) and granulocyte colony stimulating factor (G CSF). The collected cells were sorted by CD34 + Save. After CY and antithymocyte immunoglobulin (ATG) pretreatment, stem cells were transfused and G CSF was used to assist in hematopoietic reconstitution. The clinical manifestations and laboratory changes were observed after transplantation. Lymphocyte phenotype analysis before and after transplantation to monitor the immune reconstruction process. The results of the successful implementation of the mobilization of patients and preconditioning programs, stem cell infusion response well. After 12 months of follow-up, the patient’s joint swelling and pain disappeared completely, the quality of life improved significantly, ESR and C-reactive protein were reduced to normal, and the rheumatoid factor was negative. The immune reconstruction was underway. Conclusion APBSCT combined with CD34 + cells treatment of RA is safe, short-term curative effect is significant, the process of immune reconstitution needs further follow-up after transplantation