异基因造血干细胞移植后急性移植物抗宿主病的临床分析

Clinical analysis of acute graft-versus-host disease after allogeneichematopoietic stem cell transplantation

目的 探讨异基因造血干细胞移植（allo-HSCT）后急性移植物抗宿主病（aGVHD）的临床特征及疗效.方法 118例造血系统疾病患者接受allo-HSCT,可评估aGVHD者113例;回顾性研究分析aGVHD患者的临床特征和疗效.结果 发生aGVHD者54例（47.8%）,中位发病时间27天;研究发现,aGVHD患者对一线治疗有效率为66.7%,其中,32例Ⅱ～Ⅳ度aGVHD患者对甲泼尼龙有效者15例（46.9%）,激素治疗无效的aGVHD患者对二线治疗效果不佳（30.8%）;aGVHD治疗后感染并发症是导致患者死亡的主要原因,尤其见于Ⅲ～Ⅳ度aGVHD患者.移植后180天存活率分别为：0度aGVHD（89.7±4.6）%、Ⅰ度aGVHD（90.5±6.4）%,Ⅱ度aGVHD（84.7±8.1）%,Ⅲ～Ⅳ度aGVHD（32.8±24.2）%,表明Ⅲ～Ⅳ度aGVHD对移植患者早期生存有严重不良影响（P＜0.05）.结论 aGVHD是allo-HSCT后常见并发症和致死原因,感染是影响aGVHD疗效的重要原因.

Objective To investigate the clinical characteristics and therapeutic effect of acute graft-versus-host disease（aGVHD） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Method 118 patients with hematological disorders received allo-HSCT. Among them, 113 patients could be evaluated for aGVHD. The clinical characteristics and therapeutic effect of aGVHD were analyzed by retrospective method. Results Fifty four patients were experienced aGVHD and the morbidity rate was 47.8%. The median time of aGVHD occurance was 27d after allo-HSCT. The therapeutic effect rate was 66.7% in patients with the first-line therapy. Among them,The therapeutic effect rate was 46.9% in patients with grade Ⅲ～Ⅳ aGVHD. Second-line therapy for steroid refractory aGVHD was unsatisfactory. After immunosuppressive treatment for aGVHD,infection was the important complication resulting in death, especially in patients with grade Ⅲ～Ⅳ aGVHD. The 180-day survival rates after allo-HSCT were （89.7 ±4.6）% for grade 0,（90.5 ±6.4）% for grade Ⅰ ,（84.7 ±8.1）% for grade Ⅱ ,（32.8 ±24.2）% for grade Ⅲ -Ⅳ aGVHD, respectively. The results showed that grade Ⅲ -Ⅳ aGVHD had profound negative impact on early survival in patients after allo-HSCT. Conclusions aGVHD is a common complication and cause of death. Severe infection has a negative impact for aGVHD therapeutic effect.