摘要
目的:总结造血干细胞移植(HSCT)后肝脏并发症的临床类型、病因、预后、及防治策略。方法:回顾性分析2001-2006年接受HSCT的279例血液病患者中肝脏并发症的病因、危险因素、及预后并着重分析肝静脉闭塞病(HVOD)患者的临床表现、实验室检查、预后及危险因素。结果:279例HSCT患者中99例发生肝脏并发症(发生率35.48%),其中23例发生HVOD(发生率8.24%),62例发生涉及肝脏的移植物抗宿主病(GVHD),其他14例包括药物性肝损害8例,戊型肝炎2例,活动性乙型肝炎2例,胆汁淤积性肝炎1例,肝真菌病1例。截止随访结束死亡36例。23例HVOD患者,9例于移植后100d内死亡,其中7例死于HVOD引起的多脏器功能衰竭(MOF)(63.6%)。经统计学分析HSCT后肝脏并发症的危险因素有异基因造血干细胞移植(al-lo-HSCT),无关供者(UD)移植,移植前有肝炎病毒感染,肝功能异常及并发真菌感染。患肝脏并发症的HSCT患者的总生存率明显低于其他组。结论:肝脏并发症是HSCT后降低患者总生存时间的一重要因素。其中HVOD尤为严重且危险。HVOD的预防,控制肝炎病毒感染以及针对肝脏并发症高危因素筛选高危患者选择适当预处理及GVHD预防方案,有助于降低肝脏并发症的发生率,降低HSCT患者移植后的死亡率。
Objective： We conducted a survey to evaluate the incidence, prognosis and risk factors of hepatic complications after hematopoietic stem cell transplantation （HSCT）, especially hepatic veno occlusive disease （HVOD）. Method：279 blood diseases patients undergoing HSCT from 2001 to 2006 were retrospective surveyed. The clinical manifestations, laboratory examination results, prognosis, and the risk factors of hepatic complications especially HVOD were evaluated. Result：99 hepatic complications oecured in 279 patients after HSCT （incidence rate 35.48%）, 36 patients died before the end of follow-up. 23 HVOD occured in 279 patients after HSCT （incidence rate 8.24%）, 9 HVOD patients died in 100 days after HSCT, and 7 died from multiple organ failure （MOF） developed from HVOD （63.6%）. The risk factors of hepatic complications include allogeneic HSCT; unrelated donor HSCT; pretransplant hepatitis virus infection, hepatic disfunction, and mycotic infection. The risk factors of HVOD are progression phase of disease; using cyclosporine as graft versus-host disease （GVHD） prophylaxis drug; pretransplant hepatitis virus infection, hepatic disfunction, and mycotic infection; none HVOD prophylaxis. The hepatic complications or HVOD patients survival time was shorter than the other patients. Conclusion; Hepatic complication is an important factor which will decrease patients survival time. HVOD is a severe and hazardous complication after HSCT. The prophylaxis of HVOD manipulate hepatitis virus infection and aim at high risk patients choosing proper conditioning regimens and GVHD prophylaxis may be helpful in decreasing the occurrence of Hepatic complication.
出处
《临床血液学杂志》
CAS
2009年第1期10-14,共5页
Journal of Clinical Hematology
关键词
移植
肝静脉闭塞病
移植物抗宿主病
transplantation
hepatic veno-occlusive disease
graft-versus-host disease
