急性皮肤型移植物抗宿主病8例临床分析并文献复习

Clinical analysis of 8 cases with acute cutaneous graft versus host disease and literature review

目的:初步探讨异基因造血干细胞移植(allo-HSCT)后急性皮肤型移植物抗宿主病(GVHD)的临床特征,为早期诊断和治疗提供临床依据。方法:对2012年12月—2013年12月期间就诊的8例急性皮肤型GVHD患者进行观察和临床资料分析,并结合文献讨论其早期诊断和治疗方法、发病危险因素和预防措施。结果:8例患者原发病分别为:急性单核细胞白血病(2例),急性混合细胞白血病(1例),慢性粒细胞白血病(2例),急性重型再生障碍性贫血(2例),非霍奇金淋巴瘤(1例)。血缘人类白细胞抗原(HLA)全相合者5例,半相合者3例。8例患者中女4例,男4例,移植后GVHD发生时间为15 d^3个月,临床表现大多为弥漫性红斑、斑丘疹,1例表现为特征性的毛囊周围丘疹,结合皮损组织病理检查明确诊断,给予糖皮质激素联合免疫抑制剂治疗,8例患者病情均得到有效控制。结论:allo-HSCT后急性皮肤型GVHD临床表现大多无特异性,需结合病史和组织病理检查明确诊断,早期治疗预后良好。

Objective： To investigate the clinical characteristics of acute cutaneous graft versus host disease（GVHD） after allogeneic hematopoietic stem cell transplantation（allo-HSCT）, and to provide clinical evidence for early diagnosis and treatment. Methods： We analyzed clinical data from 8 patients with acute cutaneous GVHD in our department from December 2012 to December 2013. Early diagnosis and treatment, risk factors and preventive measures of acute cutaneous GVHD were discussed with literature review. Results： The primary diseases of 8 patients, 4 males and 4 females, included acute monocytic leukemia（2 cases）, mixed-lineage acute leukemia（1 case）, chronic myelocytic leukemia （2 cases）, acute severe aplastic anemia （2 cases）, and non-Hodgkin lymphoma（1 case）. 5 patients were blood human leucocyte antigen（HLA）-identical, and 3 were HLA-haploidentical. GVHD occurred 15 days to three months after transplantation. Most of patients presented with diffused erythemas and maculopapules. 1 case showed typical perifollicular papules. Diagnosis was made based on clinical manifestations and histopathological examination. Disease was under control with glucocorticoids and immunosuppressant in all 8 patients. Conclusion： The acute cutaneous GVHD has no specific clinical manifestations. Medical history and histopatho- logical examination are helpful for diagnosis. Early treatment could result in favorable prognosis.