移植物抗宿主病18例防治及效果分析  

Prevention and treatment as well as effect analysis of graft versus host disease in 18 cases

作　　者：邱大发[1] 许晓军[1] 郭子文[1] 何慧清[1] 林淑华[1] 古滔华[1] 任志娟[1] 牛晓敏[1] 黎伟超[1] 

机构地区：[1]中山大学附属中山医院血液内科,广东省中山市528403

出　　处：《中国组织工程研究与临床康复》2008年第47期9355-9358,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：中山市科技计划项目(2006C024)~~

摘　　要：选取2004-01/2007-01中山大学附属中山医院行异基因造血干细胞移植的18例患者,亲缘供者HLA全相合8例,亲缘供者HLA1个A/B/DR位点不合9例,无关供者HLA全相合1例。根据HLA配型情况而采取以低剂量环孢素+短程甲氨喋呤为基础的不同预防移植物抗宿主病方法,治疗用甲基强的松龙作为一线方案,若效果差需加用其他免疫抑制剂作为二线方案或挽救方案。慢性移植物抗宿主病以甲基强的松龙+环孢素为基本治疗方案。18例患者均获得造血重建且移植成功,其中12例患者出现急性移植物抗宿主病(66.7%),6例未出现移植物抗宿主病;HLA-A、B、DR位点全相合者发生Ⅱ～Ⅳ急性移植物抗宿主病为11.1%。而HLA上述位点不全相合发生Ⅱ～Ⅳ急性移植物抗宿主病为55.6%。7例患者出现慢性移植物抗宿主病(38.9%)。12例发生急性移植物抗宿主病的患者,治疗后10例临床缓解,2例未缓解并死亡;7例发生慢性移植物抗宿主病的患者,治疗后6例临床缓解,1例无效死亡。所有患者均未出现疾病复发。根据HLA配型不同采用相应的防治方案可以有效控制移植物抗宿主病发生。Eighteen patients undergoing allogeneic hematopoitic stem cell transplantation （allo-HSCT） at the Zhongshan Hospital, Sun Yat-sen University from January 2004 to January 2007, were enrolled. There were 8 cases of identical HLA sibling donor, 9 cases of HLA sibling donor except A/B/DR site, and 1 case of unrelated identical HLA donor. According to different conditions of donor-recipient HLA compatibility, strategies for prophylaxis of acute Graft-versus-host disease （GVHD） were made and based on combination of low-dose cyclosporine-A （CSA） and short course methotrexate （MTX）. Methylprednisolone （MP） was used as primary therapy for acute GVHD, and other immunosuppressants were administered to those who fail to respond to MP as secondary or salvage therapy. Therapy for chronic GVHD included prednisone and CSA. All 18 patients were successfully engrafted. Acute GVHD occurred in 12 of 18 patients （66.7%）. Six cases had never developed GVHD. The incidence of Grade Ⅱ-Ⅳ acute GVHD were 11.1% and 55.6% among HLA-A, B, DR identical and mismatched HSCT patients respectively. Chronic GVHD were observed in 7 of 18 patients （38.9%）. Of 12 recipients with acute GVHD, 10 achieved clinical response after treatment, and two had no response and died. Of 7 recipients with chronic GVHD, 6 achieved clinical response after treatment and one had no response and died. None of patients had tumor relapsed. GVHD could be controlled relatively efficiently by adopting different methods for prevention and treatment according to HLA-matching.

关 键 词：异基因造血干细胞移植 移植物抗宿主病 人类白细胞抗原 

分 类 号：R394.2[医药卫生—医学遗传学]