异基因造血干细胞移植后发生过客淋巴细胞综合征患儿的临床分析并文献复习  

Passenger lymphocyte syndrome after allogeneic hematopoietic stem cell transplantation and literature review

作　　者：凤婧[1] 陈剑[1] 龙燕 赵虹[1] 李林徽 杨丽艳 Feng Jing;Chen Jian;Long Yan;Zhao Hong;Li Linhui;Yang Liyan(Department of Laboratory Medicine,Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西第二医院检验科,出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《国际输血及血液学杂志》2022年第3期246-252,共7页International Journal of Blood Transfusion and Hematology

摘　　要：目的探讨异基因造血干细胞移植(allo-HSCT)后发生过客淋巴细胞综合征(PLS)患儿的临床特点、诊断和治疗方法,并且进行相关文献复习。方法选择2019年6月30日,四川大学华西第二医院收治的1例ABO血型次侧不相合allo-HSCT后发生PLS男孩为研究对象。对患儿的临床病例资料进行回顾性分析,总结其临床特点。本研究设定的检索策略为:以"过客淋巴细胞综合征""passenger lymphocyte syndrome""PLS"为中、英文关键词,分别对中国知网数据库、万方知识服务平台和PubMed数据库建库至2020年4月30日收录的未成年人(<18岁)接受allo-HSCT后PLS的相关文献进行检索,并对PLS患儿的诊治经验进行总结。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①病史采集:本例男孩年龄为2岁6个月,因"先天性角化不良"于2019年7月9日接受allo-HSCT。allo-HSCT后第5天,患儿血红蛋白(Hb)值开始呈进行性下降,总胆红素(TB)、乳酸脱氢酶(LDH)水平进行性升高;allo-HSCT后第9天Hb值下降至67 g/L,TB和LDH水平分别上升至20.5μmol/L和240 U/L。血清学检测(2019年7月17日)结果示血型为A型RhD(+),直接抗人球蛋白(DAT)(1+),吸收放散试验结果示血浆与红细胞放散液中均检出免疫球蛋白(Ig)G型抗-A,交叉配血结果示主侧相合、次侧不相合。allo-HSCT后第10天,本例男孩接受A型RhD(+)辐照红细胞1.5 U输注治疗后,Hb值短暂上升至81 g/L,但至第12天时,下降至最低(54 g/L),患儿TB和LDH水平上升至最高(分别为37.1μmol/L和509 U/L)。血型血清学检测(2019年7月20日)结果示血型为A型RhD(+),DAT(3+~4+),与同型红细胞配血结果显示主、次侧均不相合,吸收放散试验结果示血浆与红细胞放散液中检出IgG型抗-A。②诊治过程:本例患儿allo-HSCT后12 d确诊为PLS。经O型RhD(+)辐照红细胞1.5 U输注,联合免疫抑制剂和甲泼尼龙,并辅以大剂量静脉输注用免疫球蛋白(IVObjective To explore clinical features,diagnosis and treatment of patents passenger lymphocyte syndrome(PLS)after allogeneic hematopoietic stem cell transplantation(allo-HSCT),and review relevant literature.Methods A boy with PLS after allo-HSCT who was admitted to the West China Second Hospital of Sichuan University in June 30,2019 was selected as the research subject.His clinical data was retrospectively analyzed and clinical characteristics were summarized."passenger lymphocyte syndrome"and"PLS"in Chinese and English were respectively used as keywords in order to retrieve literature from China National Knowledge Infrastructure Database and Wanfang Data Knowledge Service Platform,as well as PubMed Database from establishment of database until April 30,2020.Relevant literature on PLS after allo-HSCT in patients(<18 years old)were searched,and the experience in diagnosis and treatments of PLS were summarized.The procedure followed in this study met the requirements of Declaration of the World Medical Association Helsinki revised in 2013.Results①Medical history collection:age of the boy was 2 years and 6 months,and he received allo-HSCT on July 9,2019 due to"dyskeratosis congenita".On the 5th day after allo-HSCT,his hemoglobin(Hb)value began to decrease progressively,and the levels of total bilirubin(TB)and lactate dehydrogenase(LDH)increased progressively.On the 9th day after allo-HSCT,his Hb value decreased to 67 g/L,TB and LDH levels rose to 20.5μmol/L and 240 U/L,respectively.The results of serological testing(July 17,2019)showed that his blood type was RhD(+),direct antiglobulin test(DAT)(1+),and the absorption and emission test results showed that immunoglobulin(Ig)G anti-A was detected in both plasma and red blood cell exudates.The cross-matching results showed that the primary side was compatible and the secondary side was not compatible.On the 10th day after allo-HSCT,the boy received 1.5 U of type A RhD(+)irradiated red blood cells,his Hb value briefly increased to 81 g/L,but on the 12th day,the Hb va

关 键 词：造血干细胞移植 ABO血型系统 血型不合 过客淋巴细胞综合征 儿童 

分 类 号：R725.5[医药卫生—儿科]