造血干细胞移植后非感染性肺部并发症:研究与进展

Noninfectious pulmonary complications following hematopoietic stem cell transplantation

背景:造血干细胞移植为血液系统肿瘤、实体肿瘤、免疫性及遗传性疾病患者带来了生存的希望,但移植后非感染性肺部并发症发生及死亡率高,诊断、治疗困难。目的:对造血干细胞移植后非感染性肺部并发症的发病时间、危险因素、临床表现、高分辨CT特征、组织病理、相关基因及治疗方案作一综述。方法:在标题和摘要中,以"造血干细胞移植、肺部并发症、非感染性、吡非尼酮"或"HSCT,Pulmonary complications,Non-infectious,Pirfenidone"为检索词,检索维普数据库、Pub Med数据库和Sciencedirect数据库中2005年1月至2014年10月关于造血干细胞移植后非感染性肺部并发症方面的文献。最终选择31篇文献进行综述。结果与结论:造血干细胞移植后非感染性肺部并发症发生率逐渐增多,临床症状不典型,诊断及治疗手段有限,临床上可根据其不同的发病时间、临床表现、相应的诊断标准、合适的实验室检查作出早期诊断并早期干预,尤其是胸部高分辨CT、纤支镜灌洗的应用及新型药物的及时干预,可提高患者生存率。

BACKGROUND： Hematopoietic stem cell transplantation is a promising treatment for a variety of malignant and nonmalignant disorders. But noninfectious pulmonary complications following hematopoietic stem cell transplantation are a major cause of morbidity and mortality in these patients. And the diagnosis and treatment are difficult.OBJECTIVE： To review the noninfectious pulmonary complications after hematopoietic stem cell transplantation in terms of onset time, risk factors, clinical manifestations, characteristics of the high-resolution CT,histopathological measurement, related genes and treatment options.METHODS： A computer-based search of VIP, Pub Med and Sciencedirect databases was performed for articles related to noninfectious pulmonary compli cations after hematopoietic stem cell transplantation published from January 2005 to October 2014. The key words were ＂HSCT, pulmonary complications, non-infectious, pirfenidone＂in Chinese and English in the title and abstract. Finally, 31 articles were included in result analysis.RESULTS AND CONCLUSION： The incidence of noninfectious pulmonary complications after hematopoietic stem cell transplantation has become more and more, with atypical clinical manifestations and limited diagnosisand treatments. According to the different clinical onset time, diagnostic criteria, clinical manifestations and the appropriate laboratory tests, clinicians can make early diagnosis and early intervention. Especially, the usage of high-resolution chest CT and bronchofiberscope for bronchoalveolar lavage as well as the timely drug administration can improve the survival rate of patients with noninfectious pulmonary complications after hematopoietic stem cell transplantation.