异基因造血干细胞移植后34例肠道重度移植物抗宿主病临床特点及预后分析  

Clinical Features of Severe Intestinal Graft-Versus-Host Disease in 34 Cases Following Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：罗荣牡 吴晓雄[2] 王静波[1] 张建平[1] 邹威[1] 胥方[1] 达万明[1,3] 

机构地区：[1]北京市道培医院造血干细胞移植科,北京100049 [2]解放军总医院第一附属医院血液科,北京100037 [3]解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2011年第6期1501-1504,共4页Journal of Experimental Hematology

摘　　要：本研究探讨异基因造血干细胞移植(allo-HSCT)后重度肠道移植物抗宿主病(GVHD)的临床特点和影响预后的相关因素。选择北京市道培医院2007年1月至2011年1月共710例allo-HSCT后发生重度肠道GVHD的34例患者,随访至2011年7月1日,回顾性分析患者的临床特征,采用SPSS 19.0进行单因素分析影响预后的相关因素。结果表明,重度肠道GVHD发生率为4.79%,发生中位时间为移植后29(18-210)天。18例GVHD患者接受了肠镜检查,通过肠镜下组织改变及活检组织病理学检查确诊肠道重度GVHD,其中6例合并病毒性肠炎的患者镜下可见深在溃疡,组织病理学检查提示病毒包涵体或病毒抗原阳性。甲基泼尼松龙(MP)、他克莫司(FK506)或环孢素(CsA)、CD25单克隆抗体、布地奈德口服联合治疗好转率85.29%(29/34),29例治疗好转的病例中有9例死于肠道GVHD后的其他并发症,总生存率为58.82%(20/34)。单因素分析表明,超急性移植物抗宿主病(hGVHD)是影响肠道GVHD患者总生存率的不良因素(p=0.026)。结论:早期肠镜检查是确诊重度肠道GVHD的有效的方法,联合MP、CsA或FK506、CD25单克隆抗体治疗及布地奈德口服疗效显著,加强GVHD后期并发症的治疗能提高总生存率。This study was purposed to investigate the clinical features and related factors influencing prognosis of patients with severe intestinal graft-versus-host disease（siGVHD）after allogeneic hematopoietic stem cell transplantation（allo-HSCT）.710 patients received allo-HSCT in Beijing Dao-Pei hospital from Jan 2007 to Jan 2011 were enrolled in this study.A total of 34 patients with siGVHD out of 710 patients were analyzed retrospectively,and the univariate analysis for related factors influencing prognosis were carried out by using SPSS 19.0 software.The results showed that the incidence of siGVHD was 4.79%,its medium occurrence time was 29（18-210） days after allo-HSCT.18 out of 34 patients with siGVHD received colonoscopy,among them 6 patients were complicated with viral enteritis.The deep ulcers could be found under colonoscope.Histopathologic examination revealed the viral inclusion bodies or positive viral antigen.Methylprednisolone（MP）,cyclosporine A（CsA） or tacrolimus combined CD25 monoclonal antibody and oral budesonide were used for treatment of siGVHD.29 out of 34 cases achieved complete response（CR） with CR rate of 85.29%,overall survival rate was 58.82%（20/34）.9 out of 29 cases achieving CR died of other complications.The univariate analysis of the related factor indicated the hyperacute GVHD is the adverse factor influencing overall survival of patients with siGVHD.It is concluded that early colonoscopy is an effective way for definitive diagnosis of siGVHD.The combined treatment including MP,CsA or tacrolimus,CD25 monoclonal antibody and oral budesonide shows a significant curative effects.Intensive treatment of complications in late period of GVHD can enhance the overall survival rate.

关 键 词：异基因造血干细胞移植 移植物抗宿主病 肠道移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学] R574[医药卫生—临床医学]