异基因造血干细胞移植后迟发性非感染性肺部并发症7例并文献复习  

Late -onset noninfectious pulmonary complications after allogeneic hematopoietic stem cell transplantation： report of seven cases and literature review

作　　者：李德鹏 程海[1] 李振宇[1] 黄一虹[1] 徐开林[1] 

机构地区：[1]徐州医学院附属医院血液科,江苏徐州221002

出　　处：《徐州医学院学报》2012年第11期749-751,共3页Acta Academiae Medicinae Xuzhou

基　　金：国家自然科学基金（30971281）;江苏省科教兴卫工程项目（XK2007025）

摘　　要：目的探讨异基因造血干细胞移植（allo—HSCT）后迟发性非感染性肺部并发症（LONIPC）的临床特点以及早期诊断与治疗方法。方法回顾性分析61例接受allo—HSCT治疗并存活超过3个月患者的临床资料，统计LONIPC的发生率，分析LONIPC临床特点，并对其早期诊断与治疗措施加以总结。结果61例allo—HSCT患者中位随访时间为2126（1945～2555）天。其中7例（11．5％）发生LONIPC，发病中位时问为移植后429（103～397）天。LONIPC临床特点为早期出现于咳及呼吸困难；肺部CT表现为毛玻璃样改变，片状、结节状或不规则条索状阴影；肺功能为阻塞性通气功能障碍。经糖皮质激素及静脉用丙种球蛋白治疗后6例有效、1例死亡。结论LONIPC是allo—HSCT后严重的肺部并发症，早期诊断、早期糖皮质激素联合静脉丙种球蛋白治疗可改善其预后。Objective To investigate the clinical features, early diagnosis and treatment methods of late - onset non -infectious pulmonary complications（LONIPC） after allogeneic hematopoietic stem cell transplantation（aLlo -HSCT）. Methods The clinical data of 61 patients were analyzed retrospectively, who survived for more than 3 months after re- ceiving allo - HSCT treatment. The incidence and clinical characteristics of LONIPC were analyzed, and the early diagno- sis and treatment measures of LONIPC were summarized. Results 61 cases of allo - HSCT patients with a median follow - up time was 2 126（ 1 945 - 2 555 ） days. In 61 patients, 7 cases（ 11.5% ） had LONIPC, the median onset time of LONIPC after receiving alLo - HSCT treatment was 429 （ 103 -397） days. The clinical features of LONIPC was dry cough and dyspnea, which oceured in the early stage. The lung CT scan showed ground - glass opacity, and flake, nodular, ir- regular cord - like shadows. Lung function test showed obstructive ventilatory dysfunction. After treatment with glucocor- ticoid hormone and intravenous gamma globulin, 6 cases were evaluated as effective, 1 case died. Conclusions LO- NIPC are a severe pulmonary complications, early application of glucocorticoid hormone and intravenous gamma globulin treatment can improve prognosis.

关 键 词：异基因造血干细胞移植 肺 移植物抗宿主病 

分 类 号：R733.7[医药卫生—肿瘤] R551.3[医药卫生—临床医学]