The relationship between plasma tumor necrosis factor α levels and complications after allogeneic bone marrow transplantation

目的急性移植物抗宿主病(aGVHD)是异基因骨髓移植术后的主要合并症之一,也是导致死亡的主要原因.其早期诊断及早期治疗具有重要的意义.通过对接受异基因骨髓移植的病人的研究,以明确血浆肿瘤坏死因子α(TNFα)在aGVHD的诊断中的作用.方法选择40例接受异基因骨髓移植的患者,分别检测了在骨髓移植前后血浆TNFα的水平,与临床aGVHD相比较,使用χ2检验检测不同级别aGVHD时的TNFα阳性率,采用非参数秩和检验检测感染与非感染患者间TNFα水平.结果Ⅱ级和Ⅲ-Ⅳ级aGVHD时,血浆TNFα水平呈持续性升高:分别为(0～ 4.90) μg/L和(0.25～ 4.21) μg/L,显著高于0～I级aGVHD的患者,并具有统计学差异(P＜0.001),Ⅱ级和Ⅲ～Ⅳ级患者之间差异无显著性;TNFα水平随着病情和治疗效果呈动态变化;在感染和无感染的患者相比,TNFα水平差异无显著性;预处理结束时TNFα水平对于aGVHD的预测无显著意义.结论 TNFα可作为aGVHD发生的辅助诊断指标,并可作为aGVHD与感染相鉴别的指标之一.To ascertain the implication of tumor necrosis factor alpha (TNF alpha) in the pathogenesis of acute graft-versus-host disease (aGVHD).Plasma TNF alpha levels were assessed by ELISA in 243 sera samples from 40 patients who had undergone allogeneic bone marrow transplantation (BMT). Plasma TNF alpha levels were measured before BMT and at different time points after BMT. The results were correlated with aGVHD, infection and conditioning regimen.Plasma TNF alpha levels were significantly higher in patients with grade II and grades III-IV aGVHD (0-4.90) micrograms/L and (0.25-4.21) micrograms/L, respectively than in those with grade 0 or I aGVHD, but there was no clear correlation between plasma TNF alpha levels in patients with grade II and grade III-IV aGVHD. Plasma TNF alpha levels in patients with infection were not statistically different from those in patients without infection. The conditioning regimen did not cause a significant rise in TNF alpha levels.It is indicated that TNF alpha may be useful for the diagnosis of aGVHD and for differentiation between aGVHD and other BMT related complications such as infection.PubMed中文核心期刊要目总览(PKU)中国科学引文数据库(CSCD)09625-6274