Grimm J, Zeller W, Zander A R
Bone Marrow Transplantation Unit, University Hospital Hamburg Eppendorf, Germany.
Bone Marrow Transplant. 1998 Jan;21(1):29-32. doi: 10.1038/sj.bmt.1701041.
Acute GVHD (aGVHD) is one of the major problems after allogeneic BMT. The diagnosis of aGVHD is difficult to establish, relying mainly on clinical evaluations and symptoms of aGVHD, often resembling those of organ toxicity, infection or drug rash. In 21 patients after BMT several serum cytokine levels (soluble interleukin-2 receptor (sIL-2R), sTNF-R, SCF, IL-6, IL-8, G-SCF and ICAM-1) were determined in order to evaluate their value as an indicator for aGVHD. The maximum levels of sIL-2R (and none of the other evaluated cytokines) correlated significantly (r = 0.8, P = 0.008) with the severity of aGVHD. We also found a significant correlation between the day of engraftment (neutrophil count >0.5 x 10(9)/l) and the severity of aGVHD (r = 0.5, P = 0.03): engraftment was earlier in patients without aGVHD (median of day 11) than in those with aGVHD (median of day 18). No correlation between sIL-2R and fever or organ toxicity could be found. Our data suggest that the sIL-2R level might be an indicator for aGVHD, reflecting the severity of the disease. In patients with late engraftment the risk of aGVHD seems to be increased, therefore these patients especially should be monitored closely, possibly using sIL-2R levels.
急性移植物抗宿主病（aGVHD）是异基因骨髓移植（BMT）后的主要问题之一。aGVHD的诊断很难确立，主要依赖于aGVHD的临床评估和症状，这些症状常与器官毒性、感染或药物疹的症状相似。为了评估几种血清细胞因子水平（可溶性白细胞介素-2受体（sIL-2R）、sTNF-R、干细胞因子（SCF）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、粒细胞集落刺激因子（G-SCF）和细胞间黏附分子-1（ICAM-1））作为aGVHD指标的价值，对21例BMT后的患者进行了检测。sIL-2R的最高水平（而非其他所评估的细胞因子）与aGVHD的严重程度显著相关（r = 0.8，P = 0.008）。我们还发现植入日（中性粒细胞计数>0.5×10⁹/L）与aGVHD的严重程度之间存在显著相关性（r = 0.5，P = 0.03）：无aGVHD的患者植入较早（中位数为第11天），而有aGVHD的患者植入较晚（中位数为第18天）。未发现sIL-2R与发热或器官毒性之间存在相关性。我们的数据表明，sIL-2R水平可能是aGVHD的一个指标，反映了疾病的严重程度。在植入较晚的患者中，aGVHD的风险似乎增加，因此尤其应对这些患者密切监测，可能需检测sIL-2R水平。
