骨髓移植后肝功能损害的病因分析及治疗探讨

STUDY OF ETIOLOGY AND THERAPEUTICS IN HEPATIC DYSFUNCTION FOLLOWING BONE MARROW TRANSPLANTATION

目的探讨骨髓移植（ＢＭＴ）患者肝功能损害的病因及其防治措施。方法对３６例ＢＭＴ患者分别动态检测其肝功能及肝炎病毒、ＣＭＶ病毒，肝功能损害后治疗包括停止或减量应用有关药物，常规预防性保肝治疗，加用赛诺金、环胞菌素Ａ（ＣｓＡ）、甘昔洛韦（ＤＨＰＧ）、磷钾酸钠。结果１５例异基因ＢＭＴ（Ａｌｏ－ＢＭＴ）患者肝功能１３例有异常，２１例自体ＢＭＴ（Ａｕｔｏ－ＢＭＴ）患者１３例肝功能异常（Ｐ＜０．０５），发生移植物抗宿主病（ＧＶＨＤ）者肝功能损害发生率高（Ｐ＜０．０５），ＣＭＶ感染者肝功异常率高（Ｐ＜０．００１），肝炎病毒感染者肝损发生率高（Ｐ＜０．００１）。结论ＢＭＴ患者肝功能损害与ＢＭＴ类型、ＧＶＨＤ的发生及程度及病毒感染呈显著相关。

Objective To study the etiology and therapeutics in hepatic dysfunction after bone marrow transplantation (BMT). Methods The liver function, hepatitis virus and cytomegalovirus in 36 patients were investigated dynamically. Results 13 patients developed hepatic dysfunction in 15 allogenic bone marrow receptients, there were 13 patients developed in 21 autologous bone marrow transplantation. Among the 19 patients with GVHD 14 developed hepatic dysfunction(84.4%), but in 17 patients without GVHD only 8 developed( P<0.01) . All the 6 patients infected by cytomegalovirus developed hepatic dysfunction ( P<0.05) . 14 of 16 patients developed severe hepatic dysfunction in hepatitis virus positive group. Conclusion The type of BMT, virus infection and GVHD were significantly associated with the occurence of hepatic dysfunction.