异基因外周造血干细胞移植治疗极重度骨髓型急性放射病一例  

Allogeneic peripheral blood hematopoietic stem cell transplantation for one case of extremely severe bone marrow form of acute radiation sickness

作　　者：乔建辉[1] 余长林[1] 郭梅[1] 王丹红[1] 孙琪云[1] 张石[1] 葛飞娇[1] 张锡刚[1] 李光[1] 牛文凯[1] 艾辉胜[1] 

机构地区：[1]军事医学科学院附属医院血液科全军放射病中心,北京100071

出　　处：《中华器官移植杂志》2007年第9期561-563,共3页Chinese Journal of Organ Transplantation

基　　金：国家863主题专项课题(2002AA216081)

摘　　要：目的探讨异基因外周血造血干细胞移植治疗极重度骨髓型急性放射病的效果,积累临床经验。方法1例患者意外受^(60)Co照射,受照射剂量为9～15 Gy,诊断为极重度骨髓型急性放射病,在受照射后第4天患者开始接受预处理,3 d后进行了HLA全相合的异基因外周造血干细胞移植。移植后采用环孢素A和霉酚酸酯预防移植物抗宿主病(GVHD)。结果造血功能于移植后第9天开始恢复,第11天WBC升至14.74×10~9/L,随后降至正常范围,血小板升至50×10~9/L,Hb在80 g/L以上。经短串联重复序列聚合酶链反应及血型动态检测,证实供者细胞稳定植入,原有染色体畸变和微核均消失,血型于移植后第27天完全转变为供者型。患者未发生GVHD,但放射性损伤持续加重,并发多重感染,于移植后第68天(受照射后第75天)死于多脏器功能衰竭。结论极重度骨髓型急性放射病可以通过异基因造血干细胞移植恢复造血功能,为患者存活创造机会,但仅有造血功能恢复,而未能解决好放射线对全身组织的损伤及免疫功能重建,患者仍难长期存活。Objective To explore the effects of peripheral stem cell transplantation on extremely severe bone marrow form of acute radiation sickness. Methods One patient was radiated accidently with the radiation dosage of 9- 15 Gy and diagnosed as extremely severe bone marrow form of acute radiation sickness. Pretreatment was performed at 4th day after the accident and 3 days later, HLAmatched allogeneic stem cell transplantation on the patient was performed. Graft versus host disease （GVHD） was prevented with cyclosporin A （CsA） and mycophenolate mofetil （MMF）. Results The haematopoiesis was recovered at 9th day after transplantation. At 11th day after transplantation, WBCs were increased to 14. 74 ×10^9/L and returned to the normal levels subsequently, number of platelets risen to 51 ×10^9/L and hemaglobin was over 80 g/L. TRS-PCR and blood type dynamic detection testified that the donor＇s cells were stably implanted, the chromosome aberration and micronuclei disappeared after transplantation, and the patient＇s blood type changed into the donor＇s at 27th day after transplantation. But the radiation injury were still getting worse complicated with multiple infections, At 68th day after transplantation （75 days after the accident）, the patient was died of multiple organs failure. Conclusion Extremely severe bone marrow form of ARS can achieve hematopoiesis recovery by allogeneic stem cell transplantation, but only hematopoiesis recovery can not cure the immunodefficiency and the radiation injury of the whole body.

关 键 词：外周血干细胞移植 辐射损伤 

分 类 号：R818.71[医药卫生—放射医学]