中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2010年
5期
400-404
,共5页
莫晓冬%许兰平%刘开彦%刘代红%陈欢%王峰荣%张晓辉%韩伟%陈育红%黄晓军
莫曉鼕%許蘭平%劉開彥%劉代紅%陳歡%王峰榮%張曉輝%韓偉%陳育紅%黃曉軍
막효동%허란평%류개언%류대홍%진환%왕봉영%장효휘%한위%진육홍%황효군
造血干细胞移植%移植物抗宿主病%肝脏酶学
造血榦細胞移植%移植物抗宿主病%肝髒酶學
조혈간세포이식%이식물항숙주병%간장매학
Hematopeietic stem cell transplantation%Graft-versus-host disease%Liver enzymology
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.
目的 探討異基因造血榦細胞移植(allo-HSCT)後急性移植物抗宿主病(aGVHD)組與非aGVHD組肝酶學變化特點.方法 迴顧性分析北京大學人民醫院allo-HSCT患者肝髒酶學的變化情況及與aGVHD髮生的關繫.結果 371例接受allo-HSCT患者中共有158例(41.6%)髮生Ⅰ～Ⅳ度aGVHD;中位時間為第29.5天.未髮生aGVHD組,ALT、AST、GGT、LDH升高的中位時間均在移植後20 d之內,明顯早于髮生aGVHD組.髮生aGVHD組,AST峰值明顯升高,其餘肝酶學峰值差異無統計學意義;髮生aGVHD組,AST、GGT、LDH持續時間均顯著長于未髮生aGVHD組,ALT、ALP持續時間無差異;ALT、AST、ALP、LDH升高組,aGVHD髮生的百分比明顯高于未升高組,但隻有ALT、LDH升高進入logistic模型;單純ALT、LDH升高診斷aGVHD敏感度及準確性均較差;若為移植24 d後ALT及LDH同時升高且持續時間均超過22 d,則敏感度及準確性均較好.結論 肝酶學升高,尤其是ALT、LDH的升高與aGVHD髮生相關,但作為aGVHD的診斷指標準確性欠佳;在排除藥物性肝損傷的影響下,結閤肝酶學的動力學特點,肝酶學的升高在診斷aGVHD仍有一定意義.
목적 탐토이기인조혈간세포이식(allo-HSCT)후급성이식물항숙주병(aGVHD)조여비aGVHD조간매학변화특점.방법 회고성분석북경대학인민의원allo-HSCT환자간장매학적변화정황급여aGVHD발생적관계.결과 371례접수allo-HSCT환자중공유158례(41.6%)발생Ⅰ～Ⅳ도aGVHD;중위시간위제29.5천.미발생aGVHD조,ALT、AST、GGT、LDH승고적중위시간균재이식후20 d지내,명현조우발생aGVHD조.발생aGVHD조,AST봉치명현승고,기여간매학봉치차이무통계학의의;발생aGVHD조,AST、GGT、LDH지속시간균현저장우미발생aGVHD조,ALT、ALP지속시간무차이;ALT、AST、ALP、LDH승고조,aGVHD발생적백분비명현고우미승고조,단지유ALT、LDH승고진입logistic모형;단순ALT、LDH승고진단aGVHD민감도급준학성균교차;약위이식24 d후ALT급LDH동시승고차지속시간균초과22 d,칙민감도급준학성균교호.결론 간매학승고,우기시ALT、LDH적승고여aGVHD발생상관,단작위aGVHD적진단지표준학성흠가;재배제약물성간손상적영향하,결합간매학적동역학특점,간매학적승고재진단aGVHD잉유일정의의.
Objective To investigate the characteristics of liver enzyme between acute graft-versushost disease (aGVHD) and non-aGVHD groups after allogeneic hematopoietie stem cell transplantation (allo-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 beth 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 allo-HSCT and associates with the occurrence of aGVHD, 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.
