异基因造血干细胞移植后并发Wernicke脑病一例并文献复习  

Wernicke＇s encephalopathy following allogeneic peripheral blood stem cell transplantation： report of one case and literature review

作　　者：石威[1] 仲照东[1] 吕翠芳[1] 邹玲丽 邹萍[1] 游泳[1] 胡豫[1] 

机构地区：[1]430022武汉,华中科技大学同济医学院附属协和医院血液科

出　　处：《中华器官移植杂志》2014年第1期21-24,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨异基因造血干细胞移植（HSCT）后发生Wemicke脑病的早期诊断及治疗措施。方法1例17岁白血病患者在使用全身照射＋去甲氧柔红霉素＋环磷酰胺预处理后行HLA全相合异基因HSCT，移植时输注有核细胞15．23×10^8／kg，CD34＋细胞14．47×10^6／kg。移植后给予抗CD25单抗联合环孢素A（CsA）＋短程甲氨蝶呤＋吗替麦考酚酯的方案预防移植物抗宿主病（GVHD）。结果移植后8d，受者血小板≥20×10^9／L，达到血小板植入；移植后10d，中性粒细胞绝对值≥0．5×0^9／L，达到白细胞植入；移植后28d，嵌合状态为100％供者型。受者移植后一直伴有恶心、呕吐症状；移植后54d，开始出现幻觉、震颤等中枢神经系统症状，经头颅磁共振成像检查证实为Wernicke脑病，但在开始针对性治疗时受者临床死亡。结论Wernicke脑病是HSCT后罕见的神经系统并发症，其病因为维生素Bl缺乏，早期诊断和早期治疗对于改善预后极为关键。Objective To study early diagnosis and treatment of Wernicke＇s encephalopathy （WE） in allogeneic peripheral blood stem cell transplantation recipients. Method A 17 years old patient with acute B-lymphocytic leukemia received HLA-matched nonrelative allogeneic peripheral blood stem cell transplantation after conditioning with totabbody irradiation/idamycin/ cyclophosphamide （ TBI/IDA/Cy ） regimen. CD25 monoclonal antibody and eyclosporine A＋mycophenolate mofetil ＋ methotrexate were administrated for graft versus host disease prophylaxis. Result On the day 8, the platelet was over 20 × 109/L; On the day 10, the neutrophile granulocyte was over 0. 5 × 109/L; On the day 28, full engraftment was confirmed by a bone marrow medicolegal identification. The continued nausea and vomiting after HSCT resulted in deficiency of intake and malabsorption. On the day 54, illusion and tremor occurred, and the follow-up brain MRI suggested WE, but the patient died before thiamine replacing therapy. Conclusion WE is also a rare neurologic complication of HSCT, however, it can easily be overlooked. So early radiologic surveillance and treatment for patients with WE is very important to minimize central nervous system complications and unwanted mortality.

关 键 词：造血干细胞移植 WERNICKE脑病 硫胺素 

分 类 号：R733.7[医药卫生—肿瘤]