摘要
目的总结肝移植术后移植物抗宿主病（GVHD）诊治的临床经验。方法对3例肝移植术后GVHD患者的临床表现、诊断、治疗及效果进行分析总结。3例患者均于术后3～4周左右出现不明原因高热、皮疹及胃肠道症状，继之出现全血细胞减少，肝功能无明显受损。第1例患得曾考虑为感染及变态反应，但治疗无效。第2例患者早期高度疑似GVHD。应用了大剂量甲基强地松龙激素冲击治疗。第3例患者高热后4天停用所有免疫抑制剂。但患者有FK506中毒表现。3例患者最终实验检查运动GVHD诊断。结果3例GVHD患者分别于术后37d、34d及38d死亡，死亡原因为感染及多器官功能衰竭。结论不明原因发热、皮疹、胃肠道症状应警惕GVHD的发生。通过PCRSSP方法在外周血中检测到供体淋巴细胞嵌合体有助于GVHD的诊断。停用免疫抑制剂，提高机体免疫力对抗入侵的淋巴细胞可能为更好的治疗方法。对GVHD危险因素的认识有助于预防GVHD的发生。
Objective To summarize the clinical experience of diagnosis and treatment about liver transplant-associated graft-versus host disease （LTx-GVHD）.Methods The clinical presentation, diagnosis, treatment and effect were analyzed. Three cases developed unidentified high fever, skin rash and gastrointestinal syndromes about 3 to 4 weeks after their transplant. Subsequently, pancytopenia ollured. There was no liver function damage. The first patient was considered as infection and allergic reactlon,but the treatment was no effect. The second patient was highly suspected as GVHD at the early period, great amount of methylprednisone was administered. The fever in third patient was stopped by using all the immune depressant after hyperpyrexia for four days,but the patient has drug intoxication of FKS06. Lab test of the three patients supported the di agnosis of GVHD. Results The three patients died from infection and multiple organ failure,at 37 days, 34 days and 38 days post transplantation. Conclusion We should guard against the unidentified high fever, skin rash and gastrointestianl syndromes. The diagnosis of GVHD is supported by PCR-SSP to detect peripheral blood lymphocyte chimerism. Withdrawing immunosuppression agent and improving immunity to fight against the intruding lymphocyte may be the better treatment. Recoganization of the risk factors of GVHD is helpful to prevent the happen of GVHD.
出处
《肝胆外科杂志》
2006年第2期91-94,共4页
Journal of Hepatobiliary Surgery
关键词
肝移植
移植物抗宿主病
Liver transplantaton
graft-versus-host disease GVHD
作者简介
贺强，男，硕士，副教授。研究方向：肝脏移植。
