肺移植治疗造血干细胞移植后肺部慢性移植物抗宿主病的临床分析  

Clinical analysis of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation

作　　者：凌国耀 练巧燕 李诗茵 王晓华 王璐琳[1] 廖海林 巨春蓉[1] Ling Guoyao;Lian Qiaoyan;Li Shiyin;Wang Xiaohua;Wang Lulin;Liao Hailin;Ju Chunrong(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou Respiratory Health Research Institute,Guangzhou 510012,China)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院,广州510012 [2]广州医科大学第一临床学院

出　　处：《器官移植》2024年第3期449-455,共7页Organ Transplantation

基　　金：广东省自然科学基金(2022A1515012216);广州呼吸健康研究所基金(2019GIRHZ04);广东省钟南山医学基金(ZNSA-2020013);广州呼吸健康研究院基础研究计划(202201020371)。

摘　　要：目的探讨肺移植治疗造血干细胞移植(HSCT)后肺部慢性移植物抗宿主病(cGVHD)的疗效。方法回顾性分析因肺部cGVHD接受肺移植治疗的12例患者的临床资料。分析患者的术前临床表现及累及器官,对比肺移植前后肺功能,分析患者肺移植术后生存情况。结果11例患者因原发血液系统恶性疾病行HSCT,其中白血病9例、骨髓增生异常综合征1例、淋巴瘤1例。1例因系统性红斑狼疮行HSCT。12例c GVHD患者中,8例同时累及皮肤,5例同时累及口腔,4例同时累及胃肠道,3例同时累及肝脏。12例患者肺移植术前均存在严重肺部cGVHD导致的呼吸衰竭,其中表现为Ⅱ型呼吸衰竭9例;表现为Ⅰ型呼吸衰竭3例。肺移植手术方式包括右肺移植2例、左肺移植2例、双肺移植8例。从接受HSCT到接受肺移植的间隔时间为75(19~187)个月。截至投稿日,随访时间为18(7~74)个月,其中10例患者存活,1例于术后22个月死于重症肝炎,另外1例于术后6个月死于消化道大出血,存活患者均未发现原发病复发。结论肺移植是治疗HSCT后肺部cGVHD的一种有效手段,可延长患者生存时间并提高生活质量。Objective To evaluate clinical efficacy of lung transplantation for lung chronic graft-versus-host disease(cGVHD)after hematopoietic stem cell transplantation(HSCT).Methods Clinical data of 12 patients undergoing lung transplantation for lung cGVHD were retrospectively analyzed.Preoperative clinical manifestations and involved organs of patients were analyzed.The lung function before and after lung transplantation was compared,and the survival of patients after lung transplantation was analyzed.Results Eleven patients underwent HSCT due to primary hematological malignancies,including 9 cases of leukemia,1 case of myelodysplastic syndrome,1 case of lymphoma.And 1 case underwent HSCT for systemic lupus erythematosus.Among 12 cGVHD patients,skin involvement was found in 8 cases,oral cavity involvement in 5 cases,gastrointestinal tract involvement in 4 cases and liver involvement in 3 cases.All 12 patients developed severe respiratory failure caused by cGVHD before lung transplantation,including 9 cases of typeⅡrespiratory failure and 3 cases of typeⅠrespiratory failure.Two patients underwent right lung transplantation,2 cases of left lung transplantation and 8 cases of bilateral lung transplantation.The interval from HSCT to lung transplantation was 75(19-187)months.Upon the date of submission,postoperative follow-up time was 18(7-74)months.Ten patients survived,1 died from severe hepatitis at postoperative 22 months,and 1 died from gastrointestinal bleeding at postoperative 6 months.No recurrence of primary diseases was reported in surviving patients.Conclusions Lung transplantation is an efficacious treatment for lung cGVHD after HSCT,which may prolong the survival time and improve the quality of life of the recipients.

关 键 词：肺移植 造血干细胞移植 慢性移植物抗宿主病 闭塞性细支气管炎综合征 间质性肺病 呼吸衰竭 白血病 肺功能 

分 类 号：R617[医药卫生—外科学] R55[医药卫生—临床医学]