自身骨髓移植治疗系统性红斑狼疮初探  

A pilot study in treatment of systemic lupus erythematosus by autologous bone marrow transplant

作　　者：欧阳建[1] 孙凌云[1] 杨永公[1] 陈兵[1] 韩雪莲[1] 范洵楠[1] 

机构地区：[1]南京大学医学院附属鼓楼医院血液科,210008

出　　处：《中华内科杂志》2001年第4期229-231,共3页Chinese Journal of Internal Medicine

基　　金：江苏省科委科研资助项目(BJ98302)

摘　　要：目的　探讨自身骨髓移植（ＡＢＭＴ）治疗系统性红斑狼疮（ＳＬＥ）的临床效果。方法　选迁延不愈的ＳＬＥ患者３例，硬膜外麻醉下，在髂后上棘取骨髓造血干细胞，４℃保存。预处理方案：２例为环磷酸胺１２０ｍｇ／ｋｇ，马法兰１４０ｍｇ／ｍ２；１例为环磷酸胺１２０ｍｇ／ｋｇ加ＶＰ－１６１．０ ｇ／ｍ２。预处理后回输骨髓造血干细胞。粒细胞刺激因子（Ｇ－ＣＳＦ）协助造血及免疫重建。结果　移植后３例患者临床症状均缓解，２例免疫球蛋白降低１０ｇ／Ｌ左右，补体升高，自身抗体大部分转阴。例２皮肤病理显示原有的组织损伤减轻或消失，心肌肥厚及心包积液消失。例３移植后２周心磷脂抗体转阴，２４ｈ尿蛋白定量移植前８．５０ｇ，移植３个月后减少至２．４３ｇ。结论（ｌ）ＡＢＭＴ治疗ＳＬＥ近期疗效显著。（２）疗效机制可能与预处理后组织中免疫病理细胞的减少，免疫球蛋白降低，自身抗体量的下降有关。Objective To explore the clinical effect for treatment of SLE by autologous bone marrow transplantation(ABMT). Methods Three patients with refractory SLE were chosen. BM stem cells were harvested from the posterior superior iliac crests under epidural anesthesia and preserved in 4℃. BM stem cells were reinfused after conditioned by CTX (120mg/kg) and malphalan (140mg/m2) or VP-16(1 .0g/m2). G-CSF was used to help hematopoietic and immunologic reconstitution. Results These three patients had clinical remission after transplantation;the levels of immunoglobulins declined and complements rose up. Most of the auto-antibodies turned negative. Skin pathology in case 2 showed that the former tissue injury alleviated or disappeared. Moreover, myocardial hypertrophy and pericardial effusion also disappeared.Conclusions(l) ABMT is obviously effective for SLE.The duration of remission remains to be decided in long-term follow up. (2) Mechanisms of improvement are possibly related to decrease of immunologic pathological cells in tissues after conditioning, reduction of the levevl of immunoglobulins and drop of the quantity of auto-antibodies.

关 键 词：造血干细胞移植 系统性红斑狼疮 自身骨髓移植 

分 类 号：R593.241[医药卫生—内科学] R457.7[医药卫生—临床医学]