中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
5期
394-397
,共4页
王清云%李渊%邱志祥%许蔚林%孙玉华%王莉红%王茫桔%刘微%董玉君
王清雲%李淵%邱誌祥%許蔚林%孫玉華%王莉紅%王茫桔%劉微%董玉君
왕청운%리연%구지상%허위림%손옥화%왕리홍%왕망길%류미%동옥군
移植物抗宿主病,慢性%造血干细胞移植,异基因%多浆膜腔积液
移植物抗宿主病,慢性%造血榦細胞移植,異基因%多漿膜腔積液
이식물항숙주병,만성%조혈간세포이식,이기인%다장막강적액
Graft-versus-host disease,chronic%Hematopoietic stem cell transplantation,allogeneic%Multiple effusions
目的 了解血液系统恶性肿瘤在行异基因造血干细胞移植(allo-HSCT)后以多浆膜腔积液为主要表现的慢性移植物抗宿主病(cGVHD)患者的临床特点.方法 分析2003年6月至2013年7月在北京大学第一医院血液科行allo-HSCT的323例患者中发生cGVHD的情况,对其中合并多浆膜腔积液病例的临床特点和疗效进行分析.结果 对294例行allo-HSCT后存活超过100 d患者的cGVHD和严重程度进行评价,90例(30.6％)发生cGVHD,其中广泛型cGVHD 25例(8.5％).在所有发生cGVHD患者中,4例合并中、大量多浆膜腔积液,占全部发生cGVHD病例的4.44％,均为广泛型cGVHD,其积液性质为渗出液或介于渗出液与漏出液之间.应用糖皮质激素、免疫抑制剂等治疗有效,但易反复发作.结论 多浆膜腔积液是cGVHD较为少见的临床表现,其治疗效果较差.allo-HSCT后发生cGVHD且合并多浆膜腔积液应考虑为广泛型cGVHD,应给予积极治疗.
目的 瞭解血液繫統噁性腫瘤在行異基因造血榦細胞移植(allo-HSCT)後以多漿膜腔積液為主要錶現的慢性移植物抗宿主病(cGVHD)患者的臨床特點.方法 分析2003年6月至2013年7月在北京大學第一醫院血液科行allo-HSCT的323例患者中髮生cGVHD的情況,對其中閤併多漿膜腔積液病例的臨床特點和療效進行分析.結果 對294例行allo-HSCT後存活超過100 d患者的cGVHD和嚴重程度進行評價,90例(30.6％)髮生cGVHD,其中廣汎型cGVHD 25例(8.5％).在所有髮生cGVHD患者中,4例閤併中、大量多漿膜腔積液,佔全部髮生cGVHD病例的4.44％,均為廣汎型cGVHD,其積液性質為滲齣液或介于滲齣液與漏齣液之間.應用糖皮質激素、免疫抑製劑等治療有效,但易反複髮作.結論 多漿膜腔積液是cGVHD較為少見的臨床錶現,其治療效果較差.allo-HSCT後髮生cGVHD且閤併多漿膜腔積液應攷慮為廣汎型cGVHD,應給予積極治療.
목적 료해혈액계통악성종류재행이기인조혈간세포이식(allo-HSCT)후이다장막강적액위주요표현적만성이식물항숙주병(cGVHD)환자적림상특점.방법 분석2003년6월지2013년7월재북경대학제일의원혈액과행allo-HSCT적323례환자중발생cGVHD적정황,대기중합병다장막강적액병례적림상특점화료효진행분석.결과 대294례행allo-HSCT후존활초과100 d환자적cGVHD화엄중정도진행평개,90례(30.6％)발생cGVHD,기중엄범형cGVHD 25례(8.5％).재소유발생cGVHD환자중,4례합병중、대량다장막강적액,점전부발생cGVHD병례적4.44％,균위엄범형cGVHD,기적액성질위삼출액혹개우삼출액여루출액지간.응용당피질격소、면역억제제등치료유효,단역반복발작.결론 다장막강적액시cGVHD교위소견적림상표현,기치료효과교차.allo-HSCT후발생cGVHD차합병다장막강적액응고필위엄범형cGVHD,응급여적겁치료.
Objective To analyze the clinical characteristics of polyserositis associated with chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic transplantation (allo-HSCT).Methods The occurrence rate and severity of cGVHD in 323 patients who received allo-HSCT in Peking University First Hospital from June 2003 to July 2013 were observed.Their clinical characteristics and therapeutic effect on polyserositis were analyzed as well.Results Of the 294 patients who survived for more than 100days after allo-HSCT,90 patients (30.6％) were diagnosed with cGVHD including extensive cGVHD in 25 patients (8.5％).Among the patients with cGVHD,4 patients (4.4％) developed moderate to large amount of polyserous effusions.All of these 4 patients had extensive cGVHD.The effusion was proved to be transudate or transudate-exudate.Immunosuppressive treatment was effective but unsustainable.Conclusions Polyserositis with large amount of effusion might be a rare manifestation of cGVHD and is refractory.When recurrent polyserous effusion presents with cGVHD after allo-HSCT,it should be considered as a manifestation of extensive cGVHD.Appropriate treatment should be given immediately.
