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目的探讨接受自体骨髓干细胞回输治疗的肝硬化患者外周血淋巴细胞亚群表达率和免疫球蛋白浓度变化的临床意义。方法选取2010年9月至2013年9月入住南京军区南京总院消化内科并接受自体干细胞回输治疗32例肝硬化患者,分别在采集骨髓前、采集术后第3天、术后第7天检测患者外周血的T淋巴细胞(CD3+、CD3+CD4+、CD3+CD8+)、B淋巴细胞(CD19+、CD19+CD25+)的表达率以及免疫球蛋白(Ig G、Ig A、Ig M)的血清浓度。数据采用方差分析进行统计学分析。结果入组的肝硬化患者术后第3天的CD3+、CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+细胞表达率及均明显低于骨髓采集前,术后第7天的上述指标均比术后第3天明显升高,差异具有统计学意义(FCD3=12.264、FCD4=12.834、FCD8=23.357、FCD19=5.819、FCD25=4.246;PCD3=PCD4=PCD8=0.000,PCD19=0.005,PCD25=0.019),同时,术后第7天Ig A水平明显高于骨髓采集前及术后第3天(F=7.612,P=0.001)。年龄≤55岁肝硬化患者Ig G、Ig A、Ig M水平和CD19+、CD19+、CD25+表达率在术后第3天指标均明显低于骨髓采集前,而术后第7天上述指标均高于术后第3天和骨髓采集前(FIg G=10.059、FIg A=32.271、FIg M=3.711、FCD19=104.408、FCD25=17.393;PIg G=PIg A=PCD19=PCD25=0.000,PIg M=0.030),在3个时间点CD3+CD4+、CD3+CD8+表达率均无统计学意义(FCD4=2.772、FCD8=2.934,PCD4=0.071,PCD8=0.061)。年龄大于55岁肝硬化患者术后3天和7天的CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+表达率和Ig G、Ig M水平均较骨髓采集前明显下降,术后第7天上述指标较术后第3天明显升高(FCD4=43.823、FCD8=83.762、FCD19=27.801、FCD25=36.457、FIg G=10.224、FIg M=13.528;均P<0.001)。Child B级肝硬化患者CD3+、CD3+CD4+、CD3+CD8+、CD19+、CD19+CD25+表达率和Ig G、Ig M、Ig A水平在术后第3天均低于骨髓采集前,而术后第7天上述指标均明显高于术后第3天(FCD3=9.719、FCD4=15.591、FCD8=29.480、FIg G=4.251、FIg A=7.575、FIg M=27.888、FCD19=18.286、FCD25=5.305;PCD3=PCD4=PCD8=PIg M=PCD19=0.000、PIg G=0.019、PIg A=0.001、PCD25=0.008)。Child C级组肝硬化患者的情况与Child B级组患者相似(FCD3=20.338、FCD4=26.218、FCD8=39.178、FIg G=18.790、FIg A=17.336、FIg M=8.650、FCD19=65.244、FCD25=13.667;均P<0.001)。结论接受自体骨髓干细胞回输治疗的肝硬化患者,淋巴细胞亚群表达及免疫球蛋白浓度在骨髓采集后均会出现短期的下降,为了减少该治疗的并发症,更有效地提高治疗的效果,预防感染是必要的。
Objective To investigate the clinical significance of peripheral blood lymphocyte subsets and immunoglobulin concentration in patients with cirrhosis receiving autologous bone marrow stem cell infusion. Methods From September 2010 to September 2013, 32 patients with liver cirrhosis admitted to Department of Gastroenterology, Nanjing General Hospital of Nanjing Military Command and received autologous stem cell transplantation were enrolled. Before bone marrow collection, the third day after operation and the seventh day after operation The expression of T lymphocytes (CD3 +, CD3 + CD4 +, CD3 + CD8 +), B lymphocytes (CD19 +, CD19 + CD25 +) in peripheral blood of patients and the serum concentrations of immunoglobulins . Data were analyzed by analysis of variance. Results The expression rates of CD3 +, CD3 + CD4 +, CD3 + CD8 +, CD19 +, CD19 + CD25 + on the third day after operation in the patients with cirrhosis were significantly lower than those before the bone marrow collection and on the 7th day after operation The third day after operation was significantly increased with statistical significance (FCD3 = 12.264, FCD4 = 12.834, FCD8 = 23.357, FCD19 = 5.819, FCD25 = 4.246; PCD3 = PCD4 = PCD8 = 0.000, PCD19 = 0.005, PCD25 = ), Meanwhile, the level of Ig A on the 7th postoperative day was significantly higher than that before the bone marrow collection and on the 3rd postoperative day (F = 7.612, P = 0.001). The levels of Ig G, Ig A and Ig M and the expression of CD19 +, CD19 + and CD25 + in patients with liver cirrhosis ≤ 55 years old were significantly lower than those before bone marrow collection on the 3rd day after operation, and were all higher than those on the 7th day after operation FIg A = 32.271, FIg M = 3.711, FCD19 = 104.408, FCD25 = 17.393; PIg G = PIg A = PCD19 = PCD25 = 0.000, PIg M = 0.030 on day 3 after bone marrow harvesting (FIg G = The expression rates of CD3 + CD4 + and CD3 + CD8 + at 3 time points were not statistically significant (FCD4 = 2.772, FCD8 = 2.934, PCD4 = 0.071, PCD8 = 0.061). The levels of CD3 + CD4 +, CD3 + CD8 +, CD19 +, CD19 + CD25 + and Ig G, Ig M in patients with liver cirrhosis older than 55 years old after 3 and 7 days after operation were significantly lower than those before bone marrow collection. The above indexes were significantly higher than the 3rd day after operation (FCD4 = 43.823, FCD8 = 83.762, FCD19 = 27.801, FCD25 = 36.457, FIg G = 10.224, FIg M = 13.528; all P <0.001). The levels of CD3 +, CD3 + CD4 +, CD3 + CD8 +, CD19 +, CD19 + CD25 + and Ig G, Ig M and Ig A in patients with Child Grade B cirrhosis were lower than those before bone marrow harvesting on the 3rd day after operation, The above indexes were significantly higher on the 7th day than on the 3rd postoperative day (FCD3 = 9.719, FCD4 = 15.591, FCD8 = 29.480, FIg G = 4.251, FIg A = 7.575, FIg M = 27.888, FCD19 = 18.286, FCD25 = = PCD4 = PCD8 = PIg M = PCD19 = 0.000, PIg G = 0.019, PIg A = 0.001, PCD25 = 0.008). Child C cirrhosis patients were similar to those in Child B group (FCD3 = 20.338, FCD4 = 26.218, FCD8 = 39.178, FIg G = 18.790, FIg A = 17.336, FIg M = 8.650, FCD19 = 65.244, FCD25 = 13.667; all P <0.001). Conclusion The expression of lymphocyte subsets and immunoglobulin concentration in patients with cirrhosis receiving autologous bone marrow stem cell transplantation will all have short-term decline after bone marrow harvest. In order to reduce the complications of this treatment and improve the treatment effect more effectively, Prevention of infection is necessary.