肝脏移植术后移植物抗宿主病三例报告  

Craft versus host disease after liver transplantation:a report of 3 cases

作　　者：梁廷波[1] 汤晓锋[1] 郑树森[1] 卢安卫[1] 王伟林[1] 沈岩[1] 张珉[1] 孟雪芹[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科暨肝移植科,杭州310003

出　　处：《中华医学杂志》2004年第10期826-829,共4页National Medical Journal of China

基　　金：国家"九七三"重点基础研究发展规划基金资助项目 (2 0 0 3CB5 15 5 0 0 1)

摘　　要：目的　探讨与总结肝脏移植术后移植物抗宿主病 (CVHD)的诊断及治疗经验。方法　跟踪并分析 3例原位肝脏移植患者急性GVHD的临床经过和实验室检查结果。临床表现、皮肤活检、外周血HLA及聚合酶链反应扩增短串联重复序列 (PCR -STR)检查作为其诊断依据。并对免疫抑制剂进行调整。结果　 3例在术后 3～ 8周内均出现不明原因的发热、皮疹、腹泻、中性粒细胞减少或全血细胞减少 ,期间肝功能均正常或接近正常 ,巨细胞病毒 (CMV)早期抗原 (pp6 5 )、EB病毒抗体(lgM )均阴性。术后受体外周血淋巴细胞可检测到供体HLA抗原 ,1例女性受体外周血PCR -STR检测到供体Y染色体嵌合。 3例患者最终均死于感染、消化道出血、多器官功能衰竭等并发症。结论　肝移植术后GVHD的发性并非罕见 ,早期易被误诊 ,治疗效果令人失望。Objective To document the clinical experience in the diagnosis and treatment of graftversus-host disease(GVHD) after liver transplantation.Methods Clinical course was followed up and laboratory examinations were done in 3 patients with orthotopic liver transplantation(OLT)who developed acute GVHD.The diagnosis depended on clinical manifestations,skin biopsy,HLA typing and PCR short tandem repeat(PCR-STR).Immunosuppressive drugs were transferred and adjusted.Results Ferer,skin rash,diarrhea and pancytopenia were found within 3 to 8 weeks after liver transplantation.The liver function was normal.CMV antigen(pp65)and EBV antibody(IgM)were negative.The donor's HLA was detected in the host's peripheral blood cells.One female recipient had the donor's Y chromosome microchimerism detected by PCR-STR.All 3 patients died from infection,alimentary tract bleeding,or multiple organ failure in the end.Conclusion GVHD is not a rare complication easily misdiagnosed with pessimism outcome after liver transplantation.

关 键 词：肝脏移植术 移植物抗宿主病 术后并发症 诊断依据 免疫抑制剂 

分 类 号：R657.3[医药卫生—外科学] R392.4[医药卫生—临床医学]