中西医结合预防造血干细胞移植后肝静脉闭塞病的临床观察

Preventive Effect of Integrated Chinese and Western Medicine on Hepatic Veno-occlusive Disease after Hematopoietic Stem Cell Transplantation

目的观察复方丹参注射液联合前列腺素E1、低分子肝素钙及低分子右旋糖酐对造血干细胞移植后肝静脉阻闭塞病（hepatic veno-occlusive disease,HVOD）的预防作用。方法 1998年5月-2009年12月在我院进行造血干细胞移植的患者520例,其中自体外周血干细胞移植231例,同胞间HLA全相合移植125例,非血缘关系HLA全相合/不全相合移植49例,HLA半相合移植115例。采用复方丹参注射液40-60mL,低分子右旋糖酐250-500mL,前列腺素E140-60μg,均每天1次静脉滴注;低分子肝素钙3000-5000IU,每天1次皮下注射;观察对造血干细胞移植后肝静脉闭塞病的预防作用。结果 520例患者,1例发生HVOD并死亡,发生率为0.19%,未发现明显药物不良反应,未出现凝血功能障碍。结论采用复方丹参联合前列腺素E1、低分子肝素钙及低分子右旋糖酐的中西医结合方法可有效预防肝静脉闭塞病。

Objective To investigate the effect of compound Danshen Injection combined with prostaglandin E1 low molecular weight heparin calcium to dextran-40 preventing hepatic veno-occlusive disease（HVOD）after hematopoietic stem cell transplantation（HSCT）.Methods A total of 520 patients who received HSCT in the authors＇ hospital from May 1998 and December 2009 were subjected,among whom 231 patients received autologous peripheral blood stem cell transplantation,125 received HLA-identical sibling HSCT,49 received HLA-identical/mismatched unrelated HSCT and 115 received HLA-haplotype HSCT.All patients were treated by intravenous dripping of CSI 40-60 mL,dextran-40 250-500 mL,prostaglandin-E1 40-60 μg,and subcutaneous injection of low molecular weight heparin calcium 3 000-5 000 IU every day,the preventive effect on HVOD after HSCT was observed.Results HVOD occurred and caused death only in 1 case of the 520 patients observed,the incidence was 0.19%.Neither obvious adverse reaction nor coagulation disorder was found.Conclusion Compound Danshen Injection combined with prostaglandin E1,low molecular weight heparin calcium and dextran-40 is a safe and effective protocol for the prevention of HVOD after HSCT.