慢性髓性白血病患者非血缘供者骨髓移植术后并发甲状腺功能亢进1例并文献复习  

Hyperthyroidism after Hematopoietic Stem Cell Transplantation in Chronic Myeloid Leukaemia: A Case Report and Literature Review

作　　者：臧学峰[1,2,3,4] 李渤涛[2,3,4] 庞一琳[1,2,3,4] 刘婷婷[2,3,4] 楼晓[2,3,4] 李倩[2,3,4] 江岷[2,3,4] 王雷[2,3,4] 陈虎[2,3,4] 

机构地区：[1]解放军军医进修学院,北京100853 [2]全军造血干细胞研究所,北京100071 [3]军事医学科学院附属医院造血干细胞移植科,北京100071 [4]军事医学科学院附属医院细胞与基因治疗中心,北京100071

出　　处：《现代生物医学进展》2013年第7期1292-1295,共4页Progress in Modern Biomedicine

基　　金：国家"863"重大专项课题(2011AA020114);首都临床特色应用研究(SQ2010AA0201008009)

摘　　要：目的:分析骨髓移植后引起甲状腺功能亢进的病因、临床特点、治疗及预后。方法:报道1例慢性髓性白血病患者非血缘供者骨髓移植术后并发甲状腺功能亢进随访9年的结果,并复习相关文献。结果:患者男性,21岁,确诊慢性髓性白血病后行非血缘供者骨髓移植,术后+44天,出现持续低热,抗细菌、抗病毒及抗真菌治疗均无效,排除疾病复发,查甲状腺功能提示患者从亚临床甲状腺功能亢进进展为甲状腺功能亢进,给予口服甲巯咪唑治疗2周,患者体温降至正常,血T4、fT4恢复正常,随访9年,慢性髓性白血病无复发,甲状腺功能持续正常。检索文献发现类似报道5例,对其进行归纳分析。结论:骨髓移植术后早期并发甲状腺功能亢进,可能与放化疗预处理及免疫损伤引起的破坏性甲状腺炎相关,有其独特的临床表现,极易被忽视,治疗方面可以尝试应用糖皮质激素及抗甲状腺药物。对于非血缘供者骨髓移植后不明原因发热者,应考虑到甲亢可能。Objective： To analyze the pathogenesis of hyperthyroidism after hematopoietic stem cell transplantation （HSCT）, and study the clinical characteristics, therapy and prognosis of early onset hyperthyroidism. Methods： One case of chronic myeloid leukemia （CML） after matched unrelated bone marrow transplantation （MUD-BMT） complicated with hyperthyroidism was reported, and its related literature was reviewed. Results： A 21-year-old male with a definitive diagnosis of CML came for a treatment of MUD-BMT. 44 days after transplantation, the patient presented with sustained low fever which was not response to antibiotic, antiviral or antifungal therapy. Excluded from disease recurrence, he was found to have a progress from subclinical hyperthyroidism to clinical hyperthyroidism. After two weeks therapy of methimazole, his temperature become normal, as well as T4, fT4. with a follow up of 9 years, he had no recurrence of CML and his thyroid function was normal. Retrieve documents found similar reported five cases and its inductive analysis was conducted. Conclusion： The early onset of hyperthyroidism after HSCT may due to destructive thyroiditis which is associated with conditioning regimens （consisting of high-dose radiotherapy and chemotherapy） and immune-induced injury. Its clinical feature is special, but easy to be ignored. Glucocorticoid and antithyroid drug may be a choice for treatment. As to fever of unknown origin early after HSCT, destructive thyroiditis should be taken into account.

关 键 词：造血干细胞移植 甲状腺功能亢进 破坏性甲状腺炎 慢性髓性白血病 

分 类 号：R733.72[医药卫生—肿瘤]