2026 年第 3 期 第 21 卷

异基因造血干细胞移植后免疫重建与临床预后的相关性

Correlation between immune reconstitution and clinical prognosis after allogeneic hematopoietic stem cell transplantation

作者：刘谍1夏新兰1祝久惟1安丽红1李燕2赵鹏2李艳菊2李梦醒2王季石2卢英豪2

英文作者：Liu Die1 Xia Xinlan1 Zhu Jiuwei1 An Lihong1 Li Yan2 Zhao Peng2 Li Yanju2 Li Mengxing2 Wang Jishi2 Lu Yinghao2

单位：1贵州医科大学临床医学院，贵阳550004；2贵州医科大学附属医院血液内科贵州省造血干细胞移植中心，贵阳550004

英文单位：1School of Clinical Medicine Guizhou Medical University Guiyang 550004 China; 2Department of Hematology the Affiliated Hospital of Guizhou Medical University Guizhou Hematopoietic Stem Cell Transplantation Center Guiyang 550004 China

关键词：异基因造血干细胞移植；急性移植物抗宿主病；免疫重建；淋巴细胞亚群；免疫球蛋白

英文关键词：Allogeneichematopoieticstemcelltransplantation；Acutegraft-versus-hostdisease；Immunereconstitution；Lymphocytesubsets；Immunoglobulins

• 摘要：

• 目的 探讨异基因造血干细胞移植(allo-HSCT)后患者免疫重建规律特点及其与临床预后的相关性。方法 收集2018年1月至2022年12月在贵州医科大学附属医院血液内科行allo-HSCT的208例患者的临床资料。检测移植前及移植后第30、60、90天的外周血淋巴细胞亚群计数及免疫球蛋白（Ig）水平，分析移植后免疫重建与急性移植物抗宿主病(aGVHD)及总生存期的相关性。结果 allo-HSCT后B细胞及自然杀伤细胞（NK细胞）重建速度较快，CD+8 T淋巴细胞重建速度次之，CD+3、CD+4T淋巴细胞及Ig重建速度较慢。在 allo-HSCT后第30天，发生aGVHD组的CD+4T淋巴细胞计数高于未发生aGVHD组［209(151,265)×106/L比67(37,121)×106/L］，CD+8T淋巴细胞计数、NK细胞计数低于未发生aGVHD组［94(50,137)×106/L比185(104,280)×106/L、158.0(113.8,306.8)×106/L比321.0(165.0,421.0)×106/L］（均P＜0.05）。在移植后第60天，发生aGVHD组的CD+3、CD+8T淋巴细胞、B细胞、NK细胞计数低于未发生aGVHD组（均P＜0.05）。在移植后第90天，发生aGVHD组的CD+3、CD+4、CD+8T淋巴细胞、B细胞计数低于未发生aGVHD组（均P＜0.05）。移植后发生aGVHD的中位时间在第41天，在发生aGVHD前，aGVHD发生率与移植后CD+4T淋巴细胞计数呈正相关，与CD+8T淋巴细胞、NK细胞计数以及IgG、IgA水平呈负相关（均P＜0.05）；在发生aGVHD后，aGVHD发生风险与CD+3、CD+8T淋巴细胞、B细胞计数呈负相关（均P＜0.05）。患者移植后第41天前外周血CD+4T淋巴细胞高计数组(≥130.5×106/L)比低计数组(＜130.5×106/L)有更好的生存率(P=0.016)。结论 allo-HSCT后免疫重建与aGVHD的发生及总生存期存在一定相关性，且移植后早期CD+4T淋巴细胞高计数(≥130.5×106/L)与较好的临床预后有关。

• Objective To investigate the characteristics of immune reconstitution in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its correlation with clinical prognosis. Methods The clinical data of 208 patients who underwent allo-HSCT in the Department of Hematology, the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2022 were collected. Peripheral blood lymphocyte subsets and immunoglobulin (Ig) levels were measured before transplantation and at 30th, 60th and 90th days after transplantation. The correlation between immune reconstitution and acute graft-versus-host disease (aGVHD) and overall survival was analyzed. Results The reconstitution of B cells and natural killer cells (NK cells) after allo-HSCT was faster, and the reconstitution of CD+8 T cells was the second. The reconstitution of CD+3, CD+4 T and Ig cells was slower than that after allo-HSCT. On the 30th day after allo-HSCT, the counts of CD+4 T lymphocytes in the aGVHD group were higher than those in the non-aGVHD group ［209(151,265)×106/L vs 67(37,121)×106/L］, while the counts of CD+8 T lymphocytes and NK cells in the aGVHD group were lower than those in the non-aGVHD group ［94(50,137)×106/L vs 185(104,280)×106/L、158.0(113.8,306.8)×106/L vs 321.0(165.0,421.0)×106/L］(all P＜0.05). The counts of CD+3 T, CD+8 T lymphocytes, B cells and NK cells in aGVHD group were lower than those in non-aGVHD group on the 60th day after allo-HSCT (all P＜0.05). On the 90th day after allo-HSCT, the counts of CD+3 T, CD+4 T, CD+8 T lymphocytes and B cells in the aGVHD group were lower than those in the non-aGVHD group (all P＜0.05). The median time to aGVHD was the 41st day after transplantation. The incidence of aGVHD was positively correlated with the counts of CD+4 T lymphocytes, and negatively correlated with the counts of CD+8 T lymphocytes, NK cells, IgG and IgA before the occurrence of aGVHD (all P＜0.05). The incidence of aGVHD was negatively correlated with the counts of CD+3 T, CD+8 T lymphocytes and B cells (all P＜0.05). The patients with higher peripheral blood CD+4 cell counts (≥130.5×106/L) before the 41st day after transplantation had a better survival rate than those with lower peripheral blood CD+4 cell counts (＜130.5×106/L)(P=0.016). Conclusion The immune reconstitution after allo-HSCT is correlated with the occurrence of aGVHD and overall survival, and the high CD+4 T lymphocyte counts (≥130.5×106/L) in the early stage after allo-HSCT is associated with a better prognosis.