+ W$ w: W. J7 w% V$ U m2.4树突状细胞DC是目前已知的功能最强的专职抗原提呈细胞,因而在移植中的作用受到重视。根据DC表型及功能的不同,DC可分为DC1、DC2两个亚群。研究表明不同的DC亚群可诱导不同的Th细胞分化。DC1可分泌大量的IL-12,进而激活T细胞上的IL-12受体,使其分泌INF-γ,引起Th1型免疫应答而参与GVHD发生。DC2能诱导T细胞分泌IL-10,引起Th2型免疫应答而抑制GVHD发生。在移植免疫排斥反应中DC可诱导受者对移植物的免疫应答或免疫耐受。 ; Q3 Z! ^. z) \6 `7 H / b2 p0 f# m/ j* j7 w6 M d& \5 |5 ^Klangsinsirikul等[27]分析正常供者G-PBSCT及BMT移植物的DC1、DC2数量,动员前PBSC中DC1中位数为1.7106/kg、DC2为2.3106/kg,动员后的G-PBSC中主要是成熟的DC(DC2),动员后比动员前扩增5倍,而DC1变化不大。BMT移植物中DC1为2.3106/kg、DC2为0.9106/kg,且含有不成熟DC。据报道清髓性移植后早期,宿主体内DC主要是供体来源的,BMT移植物中供体来源的不成熟DC进入受者体内可促进嵌合体的形成和移植物的植入,而G-PBSC中增多的DC2能促进Th2反应,有利于移植后免疫功能的重建,减少急性GVHD发生[18]。但输入大量的供体DC2可能会影响GVL作用,导致移植后白血病复发[28]。因此需要探讨更适当的手段调节移植物内的DC亚群,从而减少GVHD,增强GVL效应,提高存活率。5 P2 G2 L u k! Q8 i
4 P6 Z! b7 v) V4 b* p- u2.5其他骨髓移植物中还含有B细胞、CD14 单核细胞、浆细胞、间充质细胞等,它们对移植结果可能也有影响,但对它们的研究报道不多。 Z/ c7 `7 t; L/ ? K9 o3 w4 @; q( r5 \
3结语 ! m7 ^3 o& b/ X, z$ y. a3 { 2 J7 q) H% e3 @# c% A Y+ y! h- v综上所述,移植物中的各种细胞成分及其数量影响着异基因移植的结果,通过调节移植物中的细胞成分及其数量可能获得更好的移植结果。但移植的整体结果除了移植物的作用,还受原发病的状态、患者年龄、HLA相合程度、预处理方案、GVHD预防等多种因素的影响,所以评价移植物成分的作用要和移植背景相结合,且所有移植结果均由移植物中造血干细胞及其附属细胞共同完成的,它们的作用不能完全分割。明确移植物各种细胞成分及其含量对移植结果的影响,寻找更为合适的方法调节移植物的细胞成分及含量,在不同的移植背景中寻找最合适的组合和比例,从而提高异基因移植效果还需要进一步广泛的深入研究。" z2 I4 W8 D+ [" h2 G
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