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8例肝移植术后急性移植物抗宿主病的诊治体会

赵晓飞 林栋栋 李宁 臧运金 郭庆良 武聚山 孙力波

引用本文:
Citation:

8例肝移植术后急性移植物抗宿主病的诊治体会

DOI: 10.3969/j.issn.1001-5256.2018.11.025
详细信息
  • 中图分类号: R657.3

Experience in diagnosis and treatment of acute graft-versus-host disease after liver transplantation of 8 cases

  • 摘要:

    目的探讨肝移植术后急性移植物抗宿主病(aGVHD)的诊断和治疗。方法选取2011年4月-2016年8月北京佑安医院肝移植中心收治的8例肝移植术后aGVHD患者,总结其诊断要点和治疗经验。结果肝移植术后aGVHD诊断要点:(1)好发时间为肝移植术后2周2个月;(2)典型临床表现为发热、皮疹、腹泻以及全血细胞水平下降;(3)供体T淋巴细胞比例> 10%;(4)有典型的组织病理学表现。治疗经验:类固醇的总反应率约为20%50%,建议应用甲基泼尼松龙1. 5 mg·kg-1·d-1,用药时间为1周。不推荐使用大剂量糖皮质激素,以避免提升感染的发生率;大剂量的免疫抑制剂是导致aGVHD发生的原因之一,临床应注意避免过量应用免疫抑制剂;预防呼吸道感染和消化道感染十分重要;重视肠内营养; siplizumab、抗胸腺细胞球蛋白和TNFα抑制剂等二线疗法可能发挥一定的治疗作用;血液净化可有效清除体内细胞因子和炎症介质有助于aGVHD的治疗。结论发病时间、临床症状、外周血T淋巴细胞嵌合率和组织病理是肝移植术后aGVHD的诊断要点,激素冲击、减低免疫抑制剂...

     

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