摘要
目的探讨前列腺素E1脂质微球联合低分子右旋糖酐对造血干细胞移植(HSCT)后肝静脉阻塞病(HVOD)的预防作用。方法1999年5月-2007年4月进行HSCT的患者234例。其中男162例,女72例,中位年龄30·6(3～64)岁。采用前列腺素El脂质微球,同时联合低分子右旋糖酐预防HVOD,前者取10μg溶于100ml生理盐水中,静脉滴注,2次/d,自移植前7d(-7d)开始至移植后30d(+30d);后者500ml,1次/d,静滴,-1d～+5d。将患者按照年龄,乙肝病毒复制情况,疾病危险状态,全身照射情况,移植类型,异基因供体来源,异基因HLA相合程度等7个不同的因素分别分为两组,分析这些因素与HVOD发生率的相关性。结果所有患者均对药物耐受性良好,均能完成本方案全程用药,未发现明显药物不良反应,未加重出凝血功能障碍。234例患者中,2例发生HVOD并死亡,发生率为0·9%。分析HVOD的相关因素发现,乙型肝炎病毒感染是导致HVOD发生的高危因素(P<0·05)。结论采用前列腺素El脂质微球联合低分子右旋糖酐可预防异基因移植后HVOD,且安全有效,值得临床进一步推广应用。移植前有乙型肝炎病毒感染史是导致HVOD发生的高危因素。
Objective To explore the effect of lipo-prostaglandin E1 plus dextran 40 in the prophylaxis of hepatic veno-occlusive disease（HVOD） after hematopoietic stem cell（HSC） transplantation.Methods Two hundred and thirty-four patients,162 males and 72 females,mean age 30.6（ranged from 3 to 64）,were admitted during May 1999 to April 2007 and undergone HSC transplantation.Lipo-prostaglandin E1 associated with dextran 40 were administered to all patients for the prophylaxis of hepatic veno-occlusive disease.Lipo-prostaglandin E1,10μg dissolved in 100ml saline,20μg per day iv,were administered from day 7 before transplantation（-7 day） to day 30 after transplantation（＋30 day）.Dextran 40,500ml per day iv,were administered from-1 day to ＋5 day.In order to identify the risk factors inducing HVOD,patients were allocated to 2 groups according to following factors：age（〈30 years or ≥30 years）,hepatitis B virus infection（yes or no）,state of the disease（normal or high risk）,total body irradiation（yes or no）,donor source（kinship or not）,transplant type（allotransplantation or autotransplantation）,HLA compatibility（match or partially match）.Results All patients showed good tolerability to lipo-prostaglandin E1 plus dextran 40.No obvious treatment-related adverse effects or coagulation disorders were found,and all the patients completed the trial.Only 2 patients（0.9%） were diagnosed as and died of HVOD.Analysis showed that hepatitis B virus infection（HBsAg＋/HBeAg＋/HBcAb＋ or HBsAg＋/HBeAb＋/HBcAb＋） was the major risk factor for the development of HVOD（P〈0.05）.Conclusions Combined Lipo-PGE1 with dextran 40 is a safe and effective protocol for the prophylaxis of HVOD after HSC transplantation,and should be recommended for clinical use.The major risk factor for the development of HVOD is HBV infection,especially to those patients with HBsAg＋/HBeAg＋/HBcAb＋ or HBsAg＋/HBeAb＋/HBcAb＋.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2008年第7期889-891,共3页
Medical Journal of Chinese People's Liberation Army
基金
上海市卫生系统"百人计划"基金(98BR029)
关键词
前列腺素E1
右旋糖酐类
造血干细胞移植
肝静脉闭塞病
prostaglandin（PGE1）
dextrans
hematopoietic stem cell transplantion
hepatic veno-occlusive disease
作者简介
付利，医学硕士，主治医师。主要从事造血于细胞移植方面的研究
通讯作者章卫平，E-mail：zhangwp@medmail．com．cn
