移植物抗宿主病的诊断和治疗  

The dignosis and treatment of graft-versus-host disease

作　　者：刘霆[1] 

机构地区：[1]四川大学华西医院血液科,成都610041

出　　处：《中国实用内科杂志》2014年第2期132-136,共5页Chinese Journal of Practical Internal Medicine

摘　　要：移植物抗宿主病(GVHD)仍是异基因造血干细胞移植(allo-HSCT)主要的并发症。GVHD的发病机制涉及到各种因素的相互作用,包括预处理的组织损伤,炎症细胞因子释放,抗原提呈细胞活化,胸腺损害,T、B淋巴细胞的免疫性效应,最终导致GVHD靶器官损害。GVHD预防可通过提高供体-受体HLA匹配,减少预处理毒性,和改进免疫抑制药物预防方案。尽管有其疗效局限性和显著毒性,发生GVHD后的一线治疗,仍然是皮质类固醇激素。新型免疫抑制剂,靶向效应免疫细胞或炎性细胞因子的各种生物药物显示出很大的潜力,这些药物的联合可能出现更佳的治疗方案。文章对目前GVHD诊断和治疗的现状做一评述。Graft-versus-host disease（GVHD） ,both acute and chronic, remains one of the major barriers to improving out- comes after allogeneic stem cell transplantation. The pathogenesis of GVHD involves the interaction of various factors, inclu- ding the tissue injury from conditioning treatment, inflammatory cytokine release, antigen presenting cell activation, thymus damage, and the effects of T and B lymphocytes, eventually leads to target organ damage. Strategies to improve donor-recipi- ent HLA match, and to minimize conditioning toxicity, and to improve immunosuppressive drug regimen, will likely improve prophylaxis of GVHD. Therapy of established acute and chronic GVHD is still heavily dependent on corticosteroids,despite their limited efficacy and considerable toxicity. Novel agents （and/or combinations of agents）comprising pharmacologic, bio- logic and cellular therapies targeting specific steps or subsets involved in immune activation will likely comprise future ad- vances in GVHD control. This article reviews the current state of knowledge regarding the preveation and treatment of acute and chronic GVHD.

关 键 词：异基因造血干细胞移植 移植物抗宿主病 

分 类 号：R446.11[医药卫生—诊断学]