中文摘要：

目的探讨供、受者之间杀伤免疫球蛋白样受体（KIR）配体不合在非体外去除T细胞的HLA不合造血干细胞移植（HSCT）中的预后意义。方法对具有HLA—B位点及C位点配型资料的94例HLA不合行HSCT的患者进行回顾性分析。结果多因素分析表明KIR配体不合[2．833（1．286—6．241），P=0．01]和移植物中T细胞的数量[3．059（1．292—7．246）×10^8／kg，P=0．011]是急性移植物抗宿主病（aGVHD）发生的独立危险因素。在接受大量T细胞组的患者（〉1．48×10^8／kg）中，具有KIR配体不合的患者aGVHD的发生率明显高于缺乏KIR配体不合的患者（100％对63．3％，P=0．036）；KIR配体不合明显增加了HLA-C不合组患者aGVHD的发生率（80．0％对57．4％，P=0．056）；KIR配体不合还明显增加了标危患者的移植相关死亡率（50．0％对7．6％，P=0．005），从而降低了标危患者的总体生存率（50．0％对88．4％，P=0．014）。结论KIR配体不合是非体外去除T细胞的HLA不合HSCT的不良预后因素，对于供者的选择具有指导意义。

英文摘要：

Objective To evaluate the prognostic implication of the killer-immunoglobulin like receptor（KIR） ligaud mismatch in HLA mismatched hematopoietic stem cell transplantation （HSCT）. Methods Ninety-four leukemia patients undergoing uumanipulated HLA-mismatched/haploideutical blood and marrow HSCT enrolled this study. Results Multivariate analysis showed that both KIR ligand mismatch （ HR 2. 833, CI, 1. 286 - 6. 241, P = 0.01 ） and doses of T cells （ HR 3. 059, CI, 1. 292 - 7. 246, P = 0.011 ） were independent risk factors for the acute graft versus host disease （ aGVHD ）. In addition, compared to those without KIR ligand mismatch, patients with KIR ligand mismatch had the more adverse effect of ＇ high＇ dose T cells （ 〉 1.48 ×10^8/kg） on aGVHD （ 100% vs 63.3%, P = 0. 036 ）, and had more incidence of aGVHD with HLA-C mismatch （ 80.0% vs 57.4% , P = 0. 056 ）. Since multivariate analysis demonstrated that high risk leukemia was the only predictor for transplant related mortality （ TRM）, relapse and overall survival （OS）, the effect of KIR ligaud mismatch on prognosis in standard and high risk patients was further analyzed. The differences in TRM （ 50.0% vs 7.6% , P = 0.005 ） and OS （ 50.0% vs 88.4% , P = 0. 014 ） between patients with and without KIR ligand mismatch were most striking for standard risk patients. Conclusion KIR ligand mismatch is a poor prognosis factor for patients underwent HLA mismatched HSCT, and is a useful parameter for donor selection.