自体外周单核细胞治疗肌萎缩侧索硬化疗效及外周淋巴细胞变化观察
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1.南京医科大学附属逸夫医院神经内科;2.宁波市杭州湾医院神经内科;3.南京医科大学附属江宁医院神经内科

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国家自然科学基金(81671117)


Effect of autologous peripheral blood mononuclear cells on amyotrophic lateral sclerosis and changes of peripheral lymphocytes
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Department of Neurology,Sir Run Run Hospital,Nanjing Medical University

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    摘要:

    目的:探讨体外扩增的自体外周血单核细胞(Peripheral blood mononuclear cell,PBMC)对肌萎缩侧索硬化(Amyotrophic lateral sclerosis,ALS)患者的治疗作用、以及外周血淋巴细胞亚群分类与症状改善之间的关系。方法:收集2019年10月~2021年8月南京医科大学附属逸夫医院神经内科和南京中医药大学附属南京医院神经内科符合标准的ALS病例65例,分为PBMC组(PBMCs 1*106/kg体重+20%人体白蛋白100ml,33例)和对照组(20%人体白蛋白100ml,32例)。分别于治疗前、治疗后第5天及第14天,以修订版ALS功能评定量表(Revised ALS Functional Rating Scale,ALSFRS-R)评分,并测定外周血CD4+T细胞、CD8+T细胞、CD4+CD25+Foxp3+Treg细胞及CD16+CD56+NK细胞数目。结果:①PBMC组ALSFRS-R评分于治疗后第5天(30.1±3.43分)、第14天(26.5±2.00分)均较治疗前(25.3±1.39分)升高,并有统计学意义(p<0.05)。②PBMC组治疗后第5天、第14天CD8+T细胞、CD4+CD25+Foxp3+Treg细胞均增高,与对照组、PBMC治疗前比较,均有统计学意义(p<0.05);CD4+T细胞、CD16+CD56+NK细胞在PBMC组治疗前后、以及与对照组比较,均无统计学意义(p>0.05)。③患者在PBMC治疗后第5、14天时,CD8+T细胞数量与ALSFRS-R分数有相关性(p<0.05);CD4+CD25+Foxp3+Treg细胞数量与ALSFRS-R分数呈正相关(p<0.05)。结论:体外扩增的自体PBMC回输治疗可以短期改善ALS患者的临床症状,且外周血CD8+T细胞和CD4+CD25+Foxp3+Treg细胞数的变化与疾病临床进展有关系。

    Abstract:

    Objective:To explore the therapeutic effect of expanded autologous peripheral blood mononuclear cells (PBMC) in vitro on patients with amyotrophic lateral sclerosis (ALS),and the relationship between the classification of peripheral blood lymphocyte subsets and the improvement of symptoms.Methods:From October 2019 to August 2021,65 patients with ALS were collected from the Department of Neurology of Sir Run Run Hospital Affiliated to Nanjing Medical University and the Department of Neurology of Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine.They were divided into PBMC group(PBMCs 1 * 106/kg body weight+20% human albumin 100ml,33 cases) and control group(20% human albumin 100ml,32 cases).Before treatment,on the 5th and 14th days after treatment,the revised ALS Functional Rating Scale (ALSFRS-R) was used for scoring and the number of CD4+T cells,CD8+T cells,CD4+CD25+Foxp3+Treg cells and CD16+CD56+NK cells in peripheral blood were measured.Results:①The ALSFRS-R score of PBMC group was significantly higher on the 5th day (30.1 ± 3.43) and the 14th day (26.5 ± 2.00 points) after treatment than that before treatment (25.3 ± 1.39 points)(p<0.05).②CD8+T cells and CD4+CD25+Foxp3+Treg cells in PBMC group increased on the 5th and 14th day after treatment,which were significantly higher than those in control group and PBMC group before treatment(p<0.05);CD4+T cells and CD16+CD56+NK cells in PBMC group were not statistically significant before and after treatment and compared with the control group(p>0.05).③At the 5th and 14th day after PBMC treatment,the number of CD8+T cells was correlated with the ALSFRS-R score(p<0.05);The number of CD4+CD25+Foxp3+Treg cells was positively correlated with the ALSFRS-R score(p<0.05).Conclusion:The reinfusion therapy of autologous PBMC expanded in vitro can improve the clinical symptoms of ALS patients in a short time,and the changes in the number of CD8+T cells and CD4+CD25+Foxp3+Treg cells in peripheral blood are related to the clinical progress of the disease.

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  • 收稿日期:2023-03-05
  • 最后修改日期:2023-04-04
  • 录用日期:2023-05-10
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