期刊文献+

骨髓移植术后急性移植物抗宿主病肝酶学的异常特点 被引量:3

Characteristics of liver enzyme abnormalities in acute graft-versus-host disease after bone marrow transplantation
原文传递
导出
摘要 目的 探讨异基因造血干细胞移植(allo-HSCT)后急性移植物抗宿主病(aGVHD)组与非aGVHD组肝酶学变化特点.方法 回顾性分析北京大学人民医院allo-HSCT患者肝脏酶学的变化情况及与aGVHD发生的关系.结果 371例接受allo-HSCT患者中共有158例(41.6%)发生Ⅰ~Ⅳ度aGVHD;中位时间为第29.5天.未发生aGVHD组,ALT、AST、GGT、LDH升高的中位时间均在移植后20 d之内,明显早于发生aGVHD组.发生aGVHD组,AST峰值明显升高,其余肝酶学峰值差异无统计学意义;发生aGVHD组,AST、GGT、LDH持续时间均显著长于未发生aGVHD组,ALT、ALP持续时间无差异;ALT、AST、ALP、LDH升高组,aGVHD发生的百分比明显高于未升高组,但只有ALT、LDH升高进入logistic模型;单纯ALT、LDH升高诊断aGVHD敏感度及准确性均较差;若为移植24 d后ALT及LDH同时升高且持续时间均超过22 d,则敏感度及准确性均较好.结论 肝酶学升高,尤其是ALT、LDH的升高与aGVHD发生相关,但作为aGVHD的诊断指标准确性欠佳;在排除药物性肝损伤的影响下,结合肝酶学的动力学特点,肝酶学的升高在诊断aGVHD仍有一定意义. Objective To investigate the characteristics of liver enzyme between acute graft-versushost disease (aGVHD) and non-aGVHD groups after allogeneic hematopoietic stem cell transplantation (aIlo-HSCT). Methods The liver enzyme data of patients with or without aGVHD was analyzed. Results Among the 371 patients, 158 developed aGVHD(41.6% ) with a median time of 29. 5 d. In non-aGVHD group, the median elevating times of ALT, AST, GGT, LDH were all ≤20 d after transplantation, which were significantly earlier than those of aGVHD group. The peak value of AST was much higher in aGVHD group, but the remaining liver enzyme showed no significant difference. In aGVHD group, the duration of AST, GGT and LDH was significantly longer than the non-occurrence of aGVHD group, but ALT and ALP showed no difference in duration. In ALT, AST, ALP and LDH elevating group, the occurrence rate of aGVHD was significantly higher, but only ALT and LDH elevation could enter logistic regression model. The sensitivity and veracity of ALT or LDH elevating only were not very good for the diagnosis of aGVHD, but if ALT and LDH both elevated after day 24 and persisted more than 22 d, the sensitivity and veracity were better. Conclusions The change of liver enzyme is common in alIo-HSCT and associates with the occurrence of aGVltD, and the liver enzyme elevating only may not be a good diagnostic index of aGVHD. If the dynamic characteristics of liver enzyme is taken into account and the effect of drug-induced liver injury could be excluded, the elevation of liver enzyme still have the diagnostic value of aGVHD.
出处 《中华内科杂志》 CAS CSCD 北大核心 2010年第5期400-404,共5页 Chinese Journal of Internal Medicine
基金 国家杰出青年基金资助(30725038) 教育部创新团队支持计划项目(IRT0702) 国家863计划项目(2006AA02ZAO)
关键词 造血干细胞移植 移植物抗宿主病 肝脏酶学 Hematopoietic stem cell transplantation Graft-versus-host disease Liver enzymology
  • 相关文献

参考文献16

  • 1黄晓军,陈育红,韩伟,陈瑶,洪虹,陆道培.人类白细胞抗原不相合造血干细胞移植治疗白血病的临床研究[J].北京大学学报(医学版),2003,35(2):115-118. 被引量:20
  • 2Przepiorka D,Weisdorf D,Martin P,et al.1994 Consensus Conference on Acute GVHD Grading.Bone Marrow Transplant,1995,15:825-828.
  • 3Rowlings PA,Przepiorka D,Klein JP,et al.IBMTR Severity Index for grading acute graft-versus-host disease:retrospective comparison with Glucksberg grade.Br J Haematol,1997,97:855-856.
  • 4Lee KH,Choi SJ,Lee JH,et al.Prognostic factors identifiable at the time of onset of acute graft-versus-host disease after allogeneic hematopoietic cell transplantation.Haematologica,2005,90:939-948.
  • 5吉布强,郑美芳,杜小红,许兰苹.骨髓移植后肝功能损害的病因分析及治疗探讨[J].白血病,1999,8(3):154-156. 被引量:4
  • 6McDonald GB,Shulman HM,Wolford JL,et al.Liver disease after human marrow transplantation.Sem Liver Dis,1987,7:210-229.
  • 7Kim BK,Chung KW,Sun HS,et al.Liver disease during the first post-transplant year in bone marrow transplantation recipients:retrospective study.Bone Marrow Transplant,2000,26:193-197.
  • 8Ozdo gan O,Rutip S,Ahdab YA,et al.Causes and risk factors fur liver injury following bone marrow transplantation.J Clin Gastroenterol,2003,36:421-426.
  • 9许兰平,郭乃榄,郑缓,卢锡京,史琪,吴彤,范蕴明,张捷,黄晓军,张耀臣,江滨,陆道培.异基因骨髓移植的预处理相关毒性[J].中华血液学杂志,1994,15(10):511-513. 被引量:8
  • 10McDonald GB.Advances in prevention and treatment of hepatic disorders following hematopoietic cell transplantation.Best Praet Res Clin Haematol,2006,19:341-352.

二级参考文献31

共引文献135

同被引文献55

  • 1陈瑶,陆道培,刘开彦,董陆佳,任汉云,黄晓军,陈欢,刘代红,江倩,陈育红,许兰平,张耀臣,路瑾,高志勇.异基因造血干细胞移植后急性移植物抗宿主病151例危险因素分析[J].中华血液学杂志,2005,26(2):74-77. 被引量:29
  • 2包晓辰,王健民,章卫平,宋献民,冯曹波,杨建民.异基因造血干细胞移植中供受体乙肝病毒感染的意义[J].白血病.淋巴瘤,2007,16(1):33-36. 被引量:2
  • 3梁辉,陈琳军,马静秋,刘晓莉.ATG用于异体造血干细胞移植前预防移植物抗宿主反应[J].上海交通大学学报(医学版),2007,27(8):1011-1013. 被引量:16
  • 4King PD, Perry MC. Hepatotoxicity of chemotherapy. Oncologist, 2001, 6: 162-176.
  • 5Hogan WJ, Maris M, Storer B, et al. Hepatic injury after nonmyeloablative conditioning followed by allogeneic hematopoietic cell transplantation: a study of 193 patients. Blood, 2004, 103: 78-84.
  • 6Kusumi E, Kami M, Kanda R, et al. Hepatic injury following reduced intensity unrelated cord blood transplantation for aduh patients with hematological diseases. Binl Blood Marrow Transplant, 2006, 12: 1302-1309.
  • 7Jones R J, Lee KS, Beschomer WE, et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplantation, 1987, 44: 778-783.
  • 8Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant, 1995, 15: 825-828.
  • 9Ozdog an O, Ratip S, Ahdab YA, et al. Causes and risk factors for liver injury following bone marrow transplantation. J Clin Gastroenterol, 2003, 36: 421-426.
  • 10E1-Sayed MH, Ei-Haddad A, Fahmy OA, et al. Liver disease is a major cause of mortality following allogeneic bone-marrow transplantation. Eur J Gastroenterol Hepatol, 2004, 16: 1347-1354.

引证文献3

二级引证文献7

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部