芦可替尼联合人工肝治疗糖皮质激素应答不佳的重度肝脏移植物抗宿主病3例  

Rucotinib combined with artificial liver for severe hepatic graft-versus-host disease with poor glucocorticoid response:A report of 3 cases

作　　者：周兴念 赵鹏 高婷 张权 李宏 ZHOU Xing-nian;ZHAO Peng;GAO Ting;ZHANG Quan;LI Hong(The Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China;Guizhou Provincial People’s Hospital,Guiyang 550001,China)

机构地区：[1]贵州医科大学附属医院,贵阳550001 [2]贵州省人民医院

出　　处：《肝脏》2025年第2期240-244,共5页Chinese Hepatology

基　　金：国家自然科学基金(82060123);贵州省卫生健康委项目(gzwjk2019-1-082);贵州省科技厅项目(黔科合基础[2020]1Y299);贵州医科大学附属医院国自然培育项目(I-2020-12);贵州医科大学附属医院博士启动基金(gyfybsky-2021-28)。

摘　　要：目的观察芦可替尼联合人工肝治疗3例糖皮质激素应答不佳的重度肝脏移植物抗宿主病(GVHD)患者的疗效。方法回顾性收集2017年1月—2021年12月贵州医科大学附属医院感染科先后收治的异基因造血干细胞移植后发生重度肝脏GVHD患者共3例,3例患者均使用芦可替尼联合人工肝治疗,并积极预防感染和对症治疗。结果3例重度肝脏GVHD患者在进行芦可替尼联合人工肝PE+DPMAS治疗后,肝功能得到显著改善且预后良好。结论肝脏移植物抗宿主病预后极差,提倡早期诊断和早期治疗。异基因造血干细胞移植术后碱性磷酸酶、谷氨酰转肽酶早于总胆红素异常升高可能是发生慢性肝脏GVHD的重要预警指标。早期芦可替尼治疗可以改善机体免疫过度激活状态,减轻胆管上皮细胞损伤,从而减轻肝损伤,免于人工肝治疗,延长患者的生存时间。Objective To observe the efficacy of Rucotinib combined with artificial liver in the treatment of 3 cases of severe liver graft-versus-host disease(GVHD)with poor glucocorticoid response.Methods A total of 3 patients with severe liver graft-versus-host disease after allogeneic hematopoietic stem cell transplantation were retrospectively collected from January 2017 to December 2021 in the Infectious disease Department of Affiliated Hospital of Guizhou Medical University.All 3 patients were treated with Rucotinib combined with artificial liver,and received active infection prevention and symptomatic treatment.Results Three patients with severe liver GVHD were treated with Rucotinib combined with artificial liver PE and DPMAS,and the liver function was significantly improved and the prognosis was favorable.Conclusion The prognosis of liver graft-versus-host disease is poor,and early diagnosis and treatment are essential.The abnormal elevation of ALP and glutamyltranspeptide before total bilirubin after allogeneic hematopoietic stem cell transplantation may serve as an important early warning indicator of chronic liver GVHD.Early treatment with rucotinib can improve the over-activation of immune system,reduce the damage of bile duct epithelial cells,thereby reducing liver damage,avoiding artificial liver treatment,and prolonging the survival time of patients.

关 键 词：芦可替尼 人工肝 糖皮质激素 肝脏移植物抗宿主病 

分 类 号：R457[医药卫生—治疗学] R457.7[医药卫生—临床医学]