异基因造血干细胞移植后重度肠道移植物抗宿主病的临床观察  

Clinical Observation of Severe Intestinal Graft-versus-host Disease Following Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：杨华强[1] 李红[1] 李玉玲[1] 覃骏[1] 王黎[1] 闫晨华[2] 高雁群[2] 

机构地区：[1]湖北医药学院附属人民医院血液科,湖北十堰442000 [2]北京大学人民医院血液病研究所,北京100044

出　　处：《湖北医药学院学报》2015年第4期336-339,343,共5页Journal of Hubei University of Medicine

基　　金：湖北省教育厅重点项目基金资助项目(D20142104);十堰市科学技术研究与开发项目基金资助项目(14Y30)

摘　　要：目的:探讨异基因造血干细胞移植(allo-HSCT)后发生重度肠道移植物抗宿主病(GVHD)的临床特点、治疗方法和影响预后的相关因素。方法:回顾性分析3例行allo-HSCT白血病患者的临床资料,并结合相关文献进行复习。结果:2例Ph+急性淋巴细胞白血病及1例慢性粒细胞白血病慢性期患者行allo-HSCT。2例行HLA半相合和1例行HLA全相合移植。预处理方案均采用改良的马利兰/环磷酰胺(Bu/Cy)。HLA全相合移植以环孢素A(Cs A)+甲氨蝶呤(MTX)+霉酚酸酯(MMF)预防急性GVHD(a GVHD),HLA半相合移植在上述预防方案的基础上加用抗胸腺细胞球蛋白(ATG)。3例患者分别于移植后35、40和55 d并发重度肠炎,肠镜和病理活检示肠黏膜充血水肿或上皮层坏死脱落,肠腔正常结构消失,直、结肠多发性溃疡,见较多淋巴细胞和浆细胞浸润,未见巨细胞病毒(CMV)包涵体。予以免疫抑制剂为主的治疗,1例HLA半相合移植患者最后死于肺部真菌感染,另2例消化道症状得到有效控制。结论:allo-HSCT后并发GVHD所致肠炎,诊断有赖于肠镜和病理活检,治疗采用以免疫抑制剂为主的综合治疗。Objective To study the clinical features, therapeutic method and prognostic correlation factors of severe intestinal graft-versus-host disease （GVHD） following allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical dates of 3 patients with leukemia following allo-HSCT were retrospectively analyzed and related literatures were re- viewed. Results Two patients with Ph combined acute lymphocytic leukemia and one patient with chronic phase of chronic myelocytic leukemia（CML-CP） were received allo-HSCT. Two patients were received haploid hematopoietic stem cell trans- plantation,and one patient was received HLA full-identical hematopoietic stem cell transplantation according HLA coincide degree. All patients were pre-conditioned by improved busulphan/cyclophosphamid. The prevention of acute GVHD （aGVHD） were carried out in patients of HLA full -identical HSCT by using cyclosporine A（CsA） ,mycophenolate mofetil （MMF） and short course methotrexate （MTX）. HLA haploid HSCT were performed following the combined administration of the above prevention program and ATG for aGVHD. All patients had the complications of severe enteritis at 35,40 and 55 days after allo-HSCT. Enteroscopy and biopsy showed mucosal congestion and edema, apoptosis and shedding of epithelial cells, disruption of normal laminal structure and multiple ulcers in colon and rectum with massive infiltration of lymphocytes and plasma cells. No cytomegalovirus （CMV） inclusions were obseived in biopsy tissues. Immunosuppressants were basical- ly administered to all the patients. One patient died of fungal infection of lung, the symptoms of other two patients were well relieved. Conclusion Enteroscopy and biopsy are useful for the diagnosis of intestinal GVHD following allo,HSCT, andl earlytreatment of immunosuppressant is required for better outcome.

关 键 词：移植物抗宿主病 肠道 预后因素 治疗 

分 类 号：R457.7[医药卫生—治疗学]