摘要
目的观察多发性骨髓瘤（MM）患者在接受自体造血干细胞移植（auto—HSCT）后体液免疫重建的规律及其与移植后感染的关系。方法分析接受auto—HSCT的42例MM患者，分别检测其在移植前、移植后1、3、6、12、18、24个月的外周血IgG、IgA、IgM水平，并记录其在移植后1．24个月间感染的发生情况。结果IgA水平在移植后6个月内[（0．75±0．59）g／L]显著低于移植前水平[（1．04±0．70）g／L]，之后缓慢上升，移植后9个月[（0．99±0．52）g／L]达到移植前水平。IgM水平在移植后1个月内[（0．28±0．15）∥L]低于移植前水平[（0．45±0．26）g/L]，在移植后3个月[（0．50±0．26）g／L]即恢复至移植前水平。IgG在移植后1个月[（11．09±2．69）g／L]即迅速恢复至移植前水平[（9．80±2．98）g／L]，在9个月[（12．07±3．57）∥L]及以后高于移植前水平。轻链及IgD型MM患者的IgG水平在第6、9、12个月时明显低于IgG型，IgA和IgM水平的恢复程度差异无统计学意义。IgG型移植后达完全缓解的患者其[gA的恢复在3个月后显著高于接近完全缓解的患者。移植后6个月内感染的发生率显著高于移植后6—12个月（P=0．005）及12个月之后（P=0．002），感染的发生与IgA（r=-0．943，P=0．005）和IgG（r=-0．943，P=0．005）均呈负相关。病毒感染的发生率与IgA和IgG呈负相关。结论MM患者在接受auto—HSCT后各种免疫球蛋白的恢复时间不同，IgG最早恢复，IgM次之，IgA恢复最慢。移植后总感染率的发生与IgG和IgA水平呈负相关，随着IgG和IgA水平的恢复，移植后感染率逐渐下降。
Objective To study the humoral immunity reconstitution and its relationship with infec- tion in patients with multiple myeloma （MM） after undergoing autologous hematopoietic stem cell transplantation （auto-HSCT）. Methods Forty-two MM patients undergoing auto-HSCT were included in this study. Peripheral blood were obtained for immunoglobulin detection, including IgG, IgA and IgM before transplanta- tion and 1, 3, 6, 12, 18 and 24 months after transplantation. The time, type, pathogen of infection between 1 and 24 month after transplantation were analyzed. Results The level of IgA at 6 month [ （0.75 ± 0.59） g/L] after auto-HSCT was lower than that of pre-auto-HSCT [ （1.04 ±0.70） g/L] , and reached the level of pre-auto-HSCT at 9 months [ （0.99 ±0.52） g/L] after auto-HSCT. The level of IgM reached the level of pre-auto-HSCT [ （0.45 ±0.26） g/L] at 3 months after auto-ASCT [ （0.50 ±0.26） g/L]. The level of IgG reached the level of pre-auto-HSCT [ （9.80 ± 2.98 ） g/L] at 1 month after auto-HSCT （ 11.09 ± 2.69 ） g/L], and higher than that of pre-auto-HSCT at 9 months after auto-HSCT [ （12.07 ± 3.57） g/L]. The level of IgG with IgG-type MM was higher than that of patients with light-chain type and IgD-type MM at 6, 9 and 12 months after auto-HSCT. The IgA level of patients who obtained complete remission （CR） is much higher than that of patients who obtained nCR in IgG-type patients. The incidence of infection in 6 month after auto-HSCT was higher than that of （6 - 12） month and 〉 12 month after auto-HSCT. The incidence of infec- tion was strongly negative correlated with IgA （ r = - 0. 943, P = 0. 005 ） and IgG （ r = - 0.943, P = 0. 005 ） level. The frequency of viral infection was also negatively correlated with IgA and IgG. Conclusion Thereconstitution time of IgG, IgA and IgM was different in MM patients after auto-HSCT. IgG recovered first, then IgM, and IgM the last. The incidence of infection was negatively correlated with IgA and IgG. With the recovery of IgG and IgA, the incidence of infection was decreased accordingly.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2013年第4期317-322,共6页
Chinese Journal of Hematology
关键词
多发性骨髓瘤
造血干细胞移植
免疫球蛋白类
感染
Multiple myeloma
Hematopoietic stem cell transplantation
Immunoglobulins
In-fection
