CAJ | 학술논문

目的：探讨异基因造血干细胞移植（ allo－HSCT）后发生重度肠道移植物抗宿主病（ GVHD）的临床特点、治疗方法和影响预后的相关因素。方法回顾性分析3例行allo－HSCT白血病患者的临床资料，并结合相关文献进行分析。结果2例为Ph＋急性淋巴细胞白血病，1例为慢性粒细胞白血病慢性期。2例行HLA半相合和1例行HLA全相合移植。预处理方案均采用改良的马利兰／环磷酰胺（ Bu／Cy ）。 HLA全相合移植以环孢素A＋甲氨蝶呤＋霉酚酸酯预防急性GVHD，HLA半相合移植在上述预防方案的基础上加用抗胸腺细胞球蛋白。3例患者分别于移植后35，40，55 d并发重度肠炎，肠镜和病理活检示肠黏膜充血水肿或上皮层坏死脱落，肠腔正常结构消失，直、结肠多发性溃疡，见较多淋巴细胞和浆细胞浸润，未见巨细胞病毒包涵体。予以免疫抑制剂为主的治疗，1例HLA半相合移植患者最后死于肺部真菌感染，另2例消化道症状得到有效控制。结论 allo－HSCT后并发GVHD所致肠炎诊断有赖于肠镜和病理活检，治疗宜采用以免疫抑制剂为主的综合治疗。
목적：탐토이기인조혈간세포이식（ allo－HSCT）후발생중도장도이식물항숙주병（ GVHD）적림상특점、치료방법화영향예후적상관인소。방법회고성분석3례행allo－HSCT백혈병환자적림상자료，병결합상관문헌진행분석。결과2례위Ph＋급성림파세포백혈병，1례위만성립세포백혈병만성기。2례행HLA반상합화1례행HLA전상합이식。예처리방안균채용개량적마리란／배린선알（ Bu／Cy ）。 HLA전상합이식이배포소A＋갑안접령＋매분산지예방급성GVHD，HLA반상합이식재상술예방방안적기출상가용항흉선세포구단백。3례환자분별우이식후35，40，55 d병발중도장염，장경화병리활검시장점막충혈수종혹상피층배사탈락，장강정상결구소실，직、결장다발성궤양，견교다림파세포화장세포침윤，미견거세포병독포함체。여이면역억제제위주적치료，1례HLA반상합이식환자최후사우폐부진균감염，령2례소화도증상득도유효공제。결론 allo－HSCT후병발GVHD소치장염진단유뢰우장경화병리활검，치료의채용이면역억제제위주적종합치료。
Objective It is to study the clinical features, therapeutic method and prognostic correlation factors of severe in-testinal graft-versus-host disease(GVHD) following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Meth-ods The clinical dates of 3 patients with leukemia following allo-HSCT were retrospectively analysed and related literatures were reviewed.Results Two patients with Ph+acute lymphocytic leukemiain and one patient with chronic phase of chronic my-elocytic leukemia( CML-CP) were received allo-HSCT.Two patients were received haploid hematopoietic stem cell trans-plantation, and another one patient were received HLA full-identical hematopoietic stem cell transplantation according HLA co-incide degree.All patients were pre-conditioned by improved busulphan/cyclophosphamid.The prevention of acute GVHD ( aGVHD) included cyclosporine A( CsA) ,mycophenolate mofetil( MMF) and short course methotrexate ( MTX) .HLA hap-loid hematopoietic stem cell transplantation were combined with ATG.3 patients had the complications of severe enteritis in 35,40 and 55 days after allo-HSCT.Enteroscopy and biopsy showed mucosal congestion and edema, apoptosis and shedding of epithelial cells,disruption of normal laminal structure, multiple ulcers in colon and rectum with massive infiltration of lym-phocytes and plasma cells.No cytomegalovirus ( CMV) inclusions were observed in biopsy tissues.Immunosuppressants were basically administered to all the patients.One patient died of fungal infection of lung, the other two patients were controlled. Conclusion Enteroscopy and biopsy are useful for the diagnosis of intestinal GVHD following allo-HSCT,and early treatment of immunosuppressant is required for better outcome.