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：戢操[1] 张荣环[2] 李红[1] 李玉玲[1] 杨华强[1] 王黎[1] 

机构地区：[1]湖北医药学院附属人民医院,湖北十堰442000 [2]湖北省十堰市妇幼保健院,湖北十堰442000

出　　处：《现代中西医结合杂志》2015年第32期3539-3541,3545,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：湖北省教育厅重点项目(D20142104);十堰市科学技术研究与开发项目(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alloHSCT白血病患者的临床资料,并结合相关文献进行分析。结果 2例为Ph+急性淋巴细胞白血病,1例为慢性粒细胞白血病慢性期。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法兰/环磷酰胺(Bu/Cy)。HLA全相合移植以环孢素A+甲氨蝶呤+霉酚酸酯预防急性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。3例患者分别于移植后35,40,55 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,治疗宜采用以免疫抑制剂为主的综合治疗。Objective It is to study the clinical features, therapeutic method and prognostic correlation factors of severe in- testinal graft-versus-host disease（GVHD） following allogeneic hematopoietic stem cell transplantation （ allo - HSCT）. Meth- ods The clinical dates of 3 patients with leukemia following allo - HSCT were retrospectively analysed and related literatures were reviewed. Results Two patients with Ph ＋ acute lymphocytic leukemiain and one patient with chronic phase of chronic my-elocytic leukemia（CML - CP） were received allo - HSCT. Two patients were received haploid hematopoietic stem cell trans- plantation, and another one patient were received HLA full-identical hematopoietic stem cell transplantation according HLA co- incide degree. All patients were pre-conditioned by improved busulphan/cyclophosphamid. The prevention of acute GVHD （ aGVHD ） included eyclosporine A （CsA） , mycophenolate mofetil（MMF） and short course nlethotrexate （MTX）. HLA hap- loid hematopoietic stem cell transplantation were combined with ATG. 3 patients had the complications of severe enteritis in 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, multiple ulcers in colon and rectum with massive infiltration of lym- phocytes and plasma cells. No cytomegalovirns （CMV） inclusions were observed in biopsy tissues. Immunosuppressants were basically administered to all the patients. One patient died of fungal infection of lung, the other two patients were controlled. Conclusion Enteroscopy and biopsy are useful for the diagnosis of intestinal GVHD following allo - HSCT,and early treatment of immunosuppressant is required for better outcome.

关 键 词：异基因造血干细胞移植 移植物抗宿主病 肠道 预后因素 

分 类 号：R733.7[医药卫生—肿瘤]