异基因造血干细胞移植后肾脏慢性移植物抗宿主病的特征

Characteristics of nephritis chronic graft versus host disease after allogeneic hematopoietic stem cell transplantation

患者,女性,34岁,因"颜面部及双下肢浮肿半个月"于2005-02入中山大学附属第五医院,出现蛋白尿、镜下血尿。患者曾于2004-04因急性白血病行异基因外周血造血干细胞移植。对患者实施肾脏穿刺活检、病理分析及抗慢性移植物抗宿主病治疗。异基因造血干细胞移植后出现累及肾脏的慢性移植物抗宿主病罕见,而以小管间质性肾炎为病理特点的慢性移植物抗宿主病更为罕见,表现为肾小球系膜细胞无明显增殖,间质中中性粒细胞、单核细胞及淋巴细胞浸润。实验室检测抗核抗体(+),CD4减少,CD8升高,CD4/CD8下降。异基因造血干细胞移植后出现的肾脏病变为慢性移植物抗宿主病的一种少见表现,是一种自身免疫性反应,积极进行肾穿刺活检,明确病理类型非常必要,免疫抑制剂治疗有效。

A female patient aged 34 years was treated at Fifth Affiliated Hospital, Sun Yat-Sen University in February 2005, because of edema of face and lower limbs for half a month, and then developed proteinuria and microscopic hematuia. The patient with acute leukemia had received allogeneic peripheral blood hematopoietic stem cell transplantation （aUo-PBSCT） in April 2004. Renal biopsy, pathological analysis and anti-chronic graft versus host disease （cGVHD） treatment were performed. After the transplantation, the occurrence of renal cGVHD was rare, whereas the appearance of cGVHD characterized by interstitial nephritis was extremely rare. It was manifested that no obvious proliferation was seen in mesangial cells, and infiltration of neutrophil, monocyte and lymphocyte could be found in stroma. Laboratory findings showed antinuclear antibody （ANA） （＋）, CD4 reduced, CD8 increased and CD4/CD8 decreased. Nephrotic disease after aUo-PBSCT can be a rare autoimmune disease. Renal biopsy plays an important role in the pathological diagnosis. Immunodepressant has a good efficacy in＇the treatment.