血浆置换对异基因造血干细胞移植术后急性移植物抗宿主病治疗评价

Efficacy of plasma exchange in treatment of acute graft versus host disease after allogeneic hematopoietic stem cell transplantation

目的探讨血浆置换(p lasm a exchang,PE)对异基因造血干细胞移植(a llogene ic hem atopo ietic stemce ll transp lan tation,A llo-HSCT)后急性移植物抗宿主病(acu te graft versus host d isease,aGVHD)的疗效、临床意义及可能机制。方法对8例免疫抑制剂控制不佳的aGVHD患者进行了1~2次血浆置换治疗,单次置换量为2 500m l^4 000 m l,观察疗效;同时用放射免疫法测定血浆置换前后患者血清中肿瘤坏死因子-α(TNF-α)水平。结果8例患者均取得了较好的治疗效果(显效者3例,占37.5%),其中aGVHD的胃肠道症状缓解尤为明显,血浆置换后患者血清中TNF-α水平明显低于治疗前(P=0.018)。结论血浆置换能有效改善aGVHD症状,对于免疫抑制剂效果不佳,或在减量过程中复发患者均有一定效果。其机制可能为降低血清中细胞因子水平,尤其是TNF-α的水平。

Objective To evaluate the efficacy of plasma exchange（PE） in treatment of acute graft versus host disease （aGVHD） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods From October 2001 to March 2004, 8 patients received PE due to aGVHD after Allo-HSCT with little response of immuno-suppressive drugs, and the effectiveness was observed. Results The overall response rate was 100.0% and 3 cases with intestinal tract symptoms were improved prominently. The level of TNF-α in the cerum of the patients after plasma exchange was much lower than that before plasma exchange （P = 0. 018）. Conclusion Combination of PE and immuno-suppressive drugs might provide a satisfactory therapeutic modality for aGVHD after allo-HSCT.