摘要
目的分析研究异基因造血干细胞移植（allo—HSCT）后急性移植物抗宿主病（aGVHD）患者CT影像学特征和aGVHD诱导肺损伤的发病机制。方法对47例Ⅱ～Ⅳ度aGVHD患者进行胸部CT检查及aGVHD发生时血清干扰素γ（IFN—γ）和肿瘤坏死因子α（TNF-α）测定，4例抗aGVHD治疗后肺损伤疗效不佳患者进行肺组织活检，生存期〉6个月的患者定期肺功能和CT检查。结果47例患者在aGVHD后3d内CT显示20例异常，其中17例疑诊为aGVHD诱导肺损伤（5例弥漫性间质渗出、7例弥漫性间质和肺泡渗出、5例弥漫性间质和部分小叶肺泡渗出）；此外，9例患者有双侧胸腔和心包积液，4例伴心肌肥厚。血清IFN-γ和TNF-α水平在有肺损伤和无肺损伤患者分别为：（6．9±1．8）μg/L、（400±102）μg／L和（6．34±1．2）μg／L、（428±83）μg/L，两者比较差异无统计学意义（均P〉0．05）。肺组织病理显示组织结构破坏、上皮细胞损伤、间质纤维化和以T细胞或巨噬细胞为主的浸润。aGVHD治疗与肺损伤治疗有效率呈正相关（r=0．771，P=0．01）。结论肺是aGVHD作用的靶器官之一，T细胞、巨噬细胞和IFN-γ、TNF—α与aGVHD造成肺损伤有关，aGVHD肺损伤可迁延为晚期非感染性肺损伤。
Objective To investigate the characteristics of chest high-resolution computed tomography （HRCT） and pathogenesis of acute graft versus host disease （aGVHD） -induced lung injury after allogenic hematopoietic stem ceil transplantation （allo-HSCT）. Methods Chest HRCT was performed in 47 patients with aGVHD of grade Ⅱ - Ⅳ after allo-HSCT. Twenty-four of the patients underwent different treatment regimens against aGVHD. Before the treatment peripheral blood samples were collected to detect the serum interferon-γ （IFN-γ） and tumor necrosis factor-α （TNF-α）. Transbronchial biopsy was performed in 4 patients that failed to recover completely after treatment. Pulmonary function was examined in the patients who survived more than 6 months in every 3 months. Results Twenty of the 47 patients showed abnormal images by chest HRCT and 17 of the 20 patients were suspected to be with aGVHD-induced lung injury. The HRCT images were characterized by diffused interstitial infiltrate in 5 cases, diffused interstitial and alveolar infiltrate in 7 cases, and diffused interstitial and segmental lobar alveolar infiltrate in 5 cases. Nine cases had bilateral pleural effusion and hydropericardium, including 4 cases accompanied by myocardial hypertrophy. The levels of serum IFN-γ/and TNF-α of the patients with lung injury were （6. 9 ± 1.8 ） μg/L and（400 ± 102） μg/L respectively, both not significantly different from those of the patients without lung injury [ （6. 3 ± 1.2） μg/L and （428 ± 83 ） μg/L respectively, P = 0. 202, 0. 306 ]. The histopathology of the lung tissue was characterized by disorganization, epithelial cell damage, interstitial fibroplasias, and interstitial T lymphocyte or macrophage infiltrate. The effective rate of treatment for aGVHD-induced lung injury was positively correlated with that for aGVHD （r = 0. 771, P = 0. 01 ）. Eleven of the 24 patients who survived more than 6 months had abnormal pulmonary function, including 7 out of the 9 patients with aGVHD-induced lung injury and 4 out the 15 patients without aGVHD-induced lung injury. There was no significant difference in the incidence of abnormal pulmonary function between the patients with and without lung injury （P= 0. 033）. Conclusions Lung is one of the target organs of aGVHD. IFN-γ and TNF-α may play a role in the pathogenesis of aGVHD-induced lung injury. Acute GVHD-induced lung injury may progress to late-onset non-infectiouslunginjury.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第8期538-542,共5页
National Medical Journal of China
基金
国家高技术研究发展计划（2006AA0224A0）
广东省自然科学基金（07005160）
关键词
造血干细胞移植
移植物抗宿主病
肺损伤
Hematopoietic stem cell transplantation
Graft vs host disease
Lung injury
作者简介
通信作者：刘启发，Email：liuqifa@fimmu．com
