肝移植术后移植物抗宿主病的研究进展  

Research Progress of Graft-Versus-Host Disease Following Liver Transplantation

作　　者：明英姿[1] 郁孟[1] 佘兴国[1] 牛英[1] 庄权[1] 刘洪[1] 

机构地区：[1]中南大学湘雅三医院器官移植中心,湖南长沙410013

出　　处：《中国普外基础与临床杂志》2015年第12期1447-1452,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的了解肝移植术后移植物抗宿主病的特点及研究进展,以期在临床上对该疾病的诊断和治疗方面提供有指导意义的方案。方法查阅国内外关于肝移植术后移植物抗宿主病的相关文献,并结合参考骨髓移植及其他实体器官移植方面的相关文献进行总结归纳。结果肝移植术后移植物抗宿主病的发病率为0.1%~2%,死亡率>75%,但其发病机制尚不明确。诊断上多是依靠临床症状指示,通过受累器官的组织学检查和宿主存在供体淋巴细胞人类白细胞抗原(HLA)或DNA的证据来综合判断。治疗上方案众多但疗效并不显著,未形成统一标准。结论肝移植术后移植物抗宿主病是肝移植术后一项罕见的并发症且预后极差。我们应当重视移植术前的预防,尤其是供受体年龄差距不宜过大、HLA匹配的相似度等方面。同时要加强术后的防范意识,积极开展组织活检、HLA分型、嵌合体研究等进行监测。在治疗上,更广泛地开展多中心联合研究积极探索出用于临床的治疗标准。Objective To investigate characteristics and research progress of graft-versus-host disease following liver transplantation, and provide guidance for diagnosis and treatment of this disease. Methods The relevant literatures on graft-versus-host disease following liver transplantation were reviewed, and the related articles on the reference of bone marrow transplantation and other solid organ transplantation were summarized. Results The incidence of graft-versus- host disease following liver transplantation was 0.1% to 2%, and the mortality was 〉75%. The pathogenesis was not clear, and the diagnosis was based on the clinical symptoms, the histological examination, and the evidence of human leukocyte antigen （HLA） or DNA from donor lymphocytes. There were numerous treatment options, most of which, however, co^lld not work effectively. A unified standard was needed. Conclusions Graft-versus-host disease is a rare complication following liver transplantation, and prognosis is very poor. On one hand, it should be paid more attention to prevention before transplantation, such as the large age gap between donor and recipient, the similarity of HLA matching and so on. On the other hand, it should be strengthened the prevention awareness and actively carry out tissue biopsy, HLA typing, and chimera study. More studies from multiple centers should be carried out to actively explore the criteria for clinical treatment.

关 键 词：肝脏移植 移植物抗宿主病 

分 类 号：R657.3[医药卫生—外科学]