移植物抗宿主病的发生及其早期预测分析

Graft versus host disease and their early predication and analysis

目的为了探讨异基因造血干细胞移植(allo-HSCT)后移植物抗宿主病(GVHD)及不明原因水肿与GVHD的关系及其临床意义。方法对29例allo-HSCT的白血病患者进行了随访观察;将发生急性GVHD(aGVHD)或慢性GVHD(cGVHD)前有无水肿的病例分为水肿组与非水肿组进行对比分析。结果29例病人均顺利植入,15例中17例次发生GVHD,其中8例aGVHD,7例为Ⅰ、Ⅱ度,1例为肠道Ⅳ度aGVHD;9例(其中2例为aGVHD转变)cGVHD中,5/9例为局限性皮肤或口腔黏膜cGVHD,4/9例为广泛性皮肤cGVHD。17例次GVHD中,4例aGVHD和1例cGVHD患者,发生GVHD前均有不明原因的水肿,其部位为颜面及双下肢,其中4例为轻度一过性水肿,1例为中等度持续性水肿,发生时间为+23～+150d。水肿与GVHD发生时的间隔时间为7～12d。所有病例随访15个月(3～106个月),15例GVHD病人中,14例病情控制或稳定,仅1例Ⅳ度aGVHD死亡。结论水肿与GVHD似乎有关联,特别是aGVHD。allo-PBSCT后不明原因的水肿可能为GVHD预测指征,防治GVHD有积极意义。

[Objective]In order to study GVHD and correlation between unknown cause edema and GVHD and its clinical significance after allogeneic hematopoietic stem cell transplantation(allo-HSCT). It had been followed up and observed for 29 patients with leukemia underwent allo-PBSCT. Patients, with edema or not, were divided into edema group and non-edema group. They were undertook contrast and analysis. It showed that all patients were successfully engrafted. 15/29 patients had graft versus host disease (GVHD), 8 cases of them were acute GVHD, including 7cases gradeⅠ～Ⅱand one case grade Ⅳ intestinal aGVHD, 9 cases were chronic GVHD. 2 of 9 patients with cGVHD were from aGVHD. In 9 patients with cGVHD, 5 cases local skin or oral mucosa and 4 cases extensive skin cGVHD. In 5/15 patients with GVHD, there were unknown cause edema on their face or both lower extremities before 4 patients developed aGVHD and 1 patient cGVHD. 4 patients were ligh and temporary edema, another was continuing and moderate edema. The edema occurred within + 23 day to +150 day range. It was within 7 days to 12 days range from edema to GVHD. All of the patients were followed up median 15 months (3 to 106 months). In 14 of 15 patients, the GVHD had controlled or stabilized. 1 patient died of grade Ⅳ GVHD. [Conclusion] it appears that there is correlation between unknown cause edema and GVHD, particularly aGVHD. It is possible to applicate unknown cause edema of post-allogeneic hematolopoietc stem cell transplantation to predict the indication of GVHD.