CAJ | 학술논문

目的探讨肝移植后发生移植物抗宿主病(GVHD)的诊断和治疗方法.方法回顾性分析2002年4月至2006年3月间8例肝移植后发生GVHD受者的临床资料,通过观察这8例受者的临床症状与体征,以及分析肝功能、血常规、骨髓细胞学、细菌培养、病毒检测和皮肤病理学等检查结果,总结诊断与治疗经验.结果肝移植受者发生GVHD的临床表现为:术后1～4周出现发热、全身皮疹、全血细胞减少、腹泻和腹痛等,但肝功能正常.皮肤组织病理学表现为:表皮角化不良、松解,棘层细胞水肿,基底层液化变性,真皮浅层淋巴细胞浸润.8例受者经减少免疫抑制剂的用量、有效控制非特异性炎症反应、改善造血功能、防治感染和加强营养支持等治疗后,其中7例康复出院,并长期健康存活;仅1例治疗无效死亡.结论肝移植后GVHD的诊断主要依据典型的临床表现和特异性的皮肤组织病理学改变.诊断明确后应最大程度的减少免疫抑制剂的用量,有效控制GVHD引起的急性炎症反应,促进造血功能恢复.
목적 탐토간이식후발생이식물항숙주병(GVHD)적진단화치료방법.방법 회고성분석2002년4월지2006년3월간8례간이식후발생GVHD수자적림상자료,통과관찰저8례수자적림상증상여체정,이급분석간공능、혈상규、골수세포학、세균배양、병독검측화피부병이학등검사결과,총결진단여치료경험.결과 간이식수자발생GVHD적림상표현위:술후1～4주출현발열、전신피진、전혈세포감소、복사화복통등,단간공능정상.피부조직병이학표현위:표피각화불량、송해,극층세포수종,기저층액화변성,진피천층림파세포침윤.8례수자경감소면역억제제적용량、유효공제비특이성염증반응、개선조혈공능、방치감염화가강영양지지등치료후,기중7례강복출원,병장기건강존활;부1례치료무효사망.결론 간이식후GVHD적진단주요의거전형적림상표현화특이성적피부조직병이학개변.진단명학후응최대정도적감소면역억제제적용량,유효공제GVHD인기적급성염증반응,촉진조혈공능회복.
Objective To investigate the clinical experience in diagnosis and treatment of graft versus host disease (GVHD) following liver transplantation.Methods The clinical manifestation,ifferential diagnosis,nd treatment experience in GVHD following liver transplantation were reported in 8 cases.Results The patients presented high fever within one to 4 weeks after operation,hen developed skin pancytopenia,ormal liver function,nd diarrhea.Skin biopsy showed epidermal dyskeratosis and solution,ydropic degeneration of prickle cell layer,iquefaction of basal cell layer,nd lymphocytes infiltrating into supeficial dermis.Serum CMV (pp65) and IgM antibody of EBV were negative.The bone marrow biopsy showed pancytopenia with scattered lymphocytes and rare megakaryocytes revealing acute aplastic marrow.The regimen consist of corticosteroid medication,mmunosuppressive drugs adjusted,reating infection,nd promoting hematopoietic recovery.Conclusions Liver transplant associated GVHD iS a severe complication and prognosis is not pessimism.Difference diagnosis with transfusion associated GVHD,iral infection,nd drug reaction should be attentive on clinical practice.