异基因外周血造血干细胞移植治疗极重度骨髓型和肠型急性放射病的临床报告  

Clinical report of two patients diagnosed as intestinal form and extremely severe bone marrow form of acute radiation sickness treated with allogeneic peripheral stem cell transplantation

作　　者：艾辉胜[1] 余长林[1] 乔建辉[1] 郭梅[1] 张石[1] 王丹红[1] 孙琪云[1] 

机构地区：[1]解放军第307医院血液科,北京100071

出　　处：《解放军医学杂志》2007年第4期287-288,290,292,共4页Medical Journal of Chinese People's Liberation Army

基　　金：国家863计划资助项目(2002AA216081)

摘　　要：目的探讨异基因外周血造血干细胞移植在肠型和极重度骨髓型放射病救治中的作用和地位。方法山东“10·21”60Co辐射事故中2例病人受到意外照射,病例A受照射剂量20～25Gy,诊断为“肠型放射病”,病例B受照射剂量9～15Gy,诊断为“极重度骨髓型放射病”。经联合环磷酰胺、抗淋巴细胞球蛋白和氟达拉滨预处理,2例分别行HLA半相合及全相合外周血造血干细胞移植。采用环孢霉素A和骁悉方案(病例A加用CD25单抗和供者间充质干细胞)预防移植物抗宿主病(GVHD)。结果2例均移植成功,供体完全存活,移植后9～11天白细胞开始恢复,2周后白细胞恢复正常、骨髓造血重建成功。2例均未发生移植排斥和GVHD。病例A照射后33天死于败血症和多器官功能衰竭。病例B照射后75天死于心衰为主的多器官功能衰竭。结论HLA相合及半相合外周血造血干细胞移植救治极重度骨髓型和肠型急性放射病是完全可能和可行的,联合免疫抑制剂预处理对促进供体稳定植入是必要的,环孢霉素A、骁悉和CD25单抗及供者间充质干细胞对预防GVHD有重要作用。Objective To explore the clinical significance of allogeneic peripheral stem cell transplantation in the treatment of acute radiation sickness. Methods Two victims were accidentally irradiated by a ^60Co source in a nuclear accident in Jining, Shandong province, China in 2004. They were exposed to more than 20-25 Gy （patient A） and 9-15Gy （patient B） of ^60Co-ray, and were diagnosed as having developed intestinal form of acute radiation sickness （ARS） and extremely severe bone marrow form of ARS, respectively. After the treatment with the preparative regimens based on low-doses of fludarabine, antilymphocyte globulin and cyclophosphamide, the two patients successfully received HLA-haploidentical （patient A） and HLA-identical （patient B） peripheral blood stern cell transplantation （PB-SCT）, respectively, 7 days after the exposure Cyclosporin A combined with mycophenolate mofetil was used for the prevention of graft- versus-host disease （GVHD）. In addition, bone marrow mesenchymaf stem cells from a donor were administered into patient A by intra- bone marrow injection. Results Both peripheral blood and bone marrow examinations showed the recovery of hemopoiesis after PBSCT, and neither patients displayed obvious clinical signs of GVHD. However, patient A died of septicemia and multi-organ failure on day 33 after the exposure, while patient B died of heart failure dominant multi-organ failure on day 75 after the exposure. Conclusions Allogeneic PBSCT is a feasible and effective treatment for ARS, while infection and multi-organ failure are major causes of death of the patients.

关 键 词：造血干细胞移植 移植预处理 辐射损伤 极重度骨髓型急性放射病 极重度肠型急性放射病 

分 类 号：R818[医药卫生—放射医学]