摘要
目的观察异基因造血干细胞移植术后继发白癜风的情况及可能相关的因素。方法对189例接受异基因造血干细胞移植后继发白癜风的患者采用流式细胞仪测定细胞内因子和淋巴细胞亚群。结果 1189例患者中有69例出现了慢性GVHD(36.5%),继发白癜风皮肤改变的有5例(2.6%),在有c GVHD的患者中发生率明显升高(7.2%)。2经过治疗,2例因严重的c GVHD死亡,3例患者经过治疗3个月后白癜风皮肤改变逐渐好转,长期存活2年以上(HSCT后)无复发。35例白癜风患者的总B细胞明显升高,辅助T细胞明显减少;5例患者的TNF-a和IL-6的水平均明显升高,IL-2的水平也有所升高。结论 allo-HSCT后并发c GVHD的患者继发白癜风的比例较高,c GVHD病人体内T淋巴细胞活化异常及其亚群失衡可能是直接导致白癜风的发病的内在机制,环孢素联合甲基强的松龙及外用他克莫司软膏可能是较好的治疗方法。
Objective To investigate the prevalence and potential correlation factors of vitiligo after allogenic haematopoietic stem cell transplantation （allo - HSCT）. Methods The development of vitiligo was analyzed among 189 patients who underwent allo - HSCT, Flow cytometry be using to detect the cytokine and lymphocyte subsets. Results Among 189 patients, sixty nine （36. 5% ） patients developed chronic graft -versus -host disease （cGVHD）, and five of which occurred vitiligo. The five patients of vitiligo all accompanied by significant cGVHD. After treatment, 2 case died due to severe cGVHD, and three others after 3 months of treatment, the vitiligo skin changes significantly improved, and long - term survival of more than 2 years （ allo - HSCT later） without recurrence. Finally,for 5 cases of vitiligo patients, total B cells was significantly higher, both helper T（Th） cells and the rate of Th/inhibition of T（Ts） were significantly reduced, and the cytokines TNF - a, IL - 6 and IL - 2 levels were significantly increased. Conclusion In patients with allo - HSCT complicated by eGVHD, there was relatively higher occurring rate of vitiligo, the abnormal activation of T lymphocytes and their subsets imbalance of cGVHD patient may be a direct result of the internal mechanism of the onset of vitiligo; Cyclosporine combined methylprednisolone and topical taerolimus ointment may be a better treatment.
出处
《医药论坛杂志》
2014年第11期30-32,共3页
Journal of Medical Forum
