单倍体外周血造血干细胞移植治疗肠型急性放射病  

Transplantation of HLA haploidentical peripheral blood stem cell for the treatment of intestinal form of acute radiation sickness

作　　者：余长林[1] 乔建辉[1] 郭梅[1] 王丹红[1] 孙琪云[1] 张石[1] 姜维浩[1] 张锡刚[2] 王浩春[2] 陈艳琴[1] 艾辉胜[1] 

机构地区：[1]解放军第307医院血液科,北京100071 [2]解放军第307医院ICU,北京100071

出　　处：《解放军医学杂志》2007年第5期437-440,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：目的探讨单倍体外周血造血干细胞移植在救治肠型急性放射病中的作用。方法山东“10·21”辐射事故患者“A”受到^(60)Coγ射线全身相对均匀照射达20～25Gy,诊断肠型急性放射病。照射后3天全环境保护、抗感染、刺激因子、HLA配型等,给予“环磷酰胺(CTX)+ATG+氟达拉滨”预处理,7天行同胞间单倍体外周血造血干细胞移植,采用“环孢霉素A(CsA)/FK506+骁悉(MMF)+CD25+间充质干细胞(MSC)”预防移植物抗宿主病(GVHD),并给予对症支持治疗。结果17天白细胞开始上升,19天重建造血:白细胞数>5×109/L,中性粒细胞绝对值>4×109/L,血小板>30×109/L,网织红细胞恢复正常。多种检测证明稳定完全植入,未发生GVHD。19天发生肺部细菌及真菌混合感染,放射损伤及肺部感染逐渐加重,33天死于多脏器功能衰竭(MOF)。结论本例是国内肠型急性放射病造血干细胞移植首次成功报告,延长了存活时间,对类似病例的救治有重要指导意义。Objective To investigate the significance of HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness. Methods Patient ＂A＂ from Shandong province suffered from a ^60Co radiation accident with a dose of 20-25Gy, and was diagnosed as intestinal form of acute radiation sickness. On the 3M day after irradiation, total environmental protection （TEP）, antibiotics treatment and emergency HLA zygosity with his elder sister were done, and HLA haploidentical peripheral blood stem cell transplantation was performed with a preconditioning regimen of ＂CTX＋ATG＋Flu＂. The regimen for protecting from GVHD was ＂CsA/FK506 ＋ MMFq-CD25--MSC＇. Results WBC began to increase on the 17th day after treatment, and WBC recovered to 5. 1 × 10^9/L on the 19th day, platelet to over 30 ×10^9）/L, and RCT to normal. Bone marrow image showed hematopoietic recovery of the three cell lineages. Continuously detection of the implantation ratio of donor＇s cells by STR-PCR, sexual chromosome analysis and HLA zygosity showed stable complete donor-derived chimera. No GVHD was observed. On the 19th days after treatment, chest X-ray films and CT suggested that a mixed bacterial and fungous infection existed in the patient＇s lungs. The severest skin damage occurred on the 25th day which occupied 14 % of whole body surface. The functions of Lung, kidney and heart were damaged sequentially. The patient died of multiple organ failure （MOF） 33 days after admission. Conclusion It is the first time to report a successful HLA haploidentical peripheral blood stem cell transplantation for the treatment of intestinal form of acute radiation sickness in China. A successful transplantation might be a key for prolonging the survival period of such a patient.

关 键 词：急性放射病 辐射损伤 造血干细胞移植 多脏器功能衰竭 肠型 

分 类 号：R818.05[医药卫生—放射医学]