异基因造血干细胞移植后患者肝损害病因与临床特征分析

 【摘要】　目的　总结异基因造血干细胞移植（allo-HSCT）后患者肝损害的发生率、发生原因、诊断方法与治疗选择。方法　回顾性分析郑州大学附属肿瘤医院2006～2010年接受allo-HSCT的83例良、恶性血液病患者中Ⅱ～Ⅳ级肝损害的发生率、各种病因的构成比、临床表现以及诊断方法，分析移植后不同时期肝损害病因的差异、治疗方法、疗效。结果　83例allo-HSCT患者中，发生Ⅱ～Ⅳ级肝损害45例（54.2 %）。按肝损害致病病因分类，预处理化疗所致7例，环孢素所致9例，肝静脉闭塞病（HVOD）所致2例，肝脏移植物抗宿主病（GVHD）所致24例，乙型肝炎病毒再激活所致2例，多器官衰竭所致1例。发生于移植后1个月内者20例（44.4 %），以药物性肝损害为主，1个月～100 d者13例（28.9 %），101 d～1年者12例（26.7 %），均以肝脏GVHD为主。经减停肝损害药物、抗排异、保肝等治疗后，27例治愈，10例好转，2例未愈，6例死于原发病复发或移植相关并发症。结论　肝损害是allo-HSCT后常见的并发症，药物及肝脏GVHD是其最主要的致病原因，肝损害与其发生时间的相关性可作为肝损害病因学诊断的参考依据。根据肝损害的病因选择针对性的治疗方法，可取得较好的疗效。

Etiology and clinical features of hepatic dysfunction in patients after allogeneic hematopoietic stem cell transplantation

Objective To summarize and evaluate the incidence, etiology, diagnostic and therapeutic method of hepatic dysfunction after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods 83 blood disease patients who undergoing allo-HSCT from 2006 to 2010 in the affiliated cancer hospital of Zheugzhou university. Among those who suffered from II -IV grade hepatic dysfunction, the incidence, the ratio of different causes, clinical feature and diagnostic method were evaluated. The difference of causes of hepatic dysfunction in different period, the therapeutic method and curative effect were also analysed. Results Among 83 patients undergoing allo-HSCT, 45 patients suffered from II-IV grade hepatic dysfunction, the ratio was 54.2 %. For etiology, 7 were preconditioning, 9 were cyclosporine （CsA）, 2 were hepatic venoocclusive disease （HVOD）, 24 were hepatic graft versus host disease （GVHD）, 2 was hepatic B virus （HBV） reactivation, 1 was mutiple organ failure. 20 cases （44.4 %） occurred in one month after all6-HSCT with the main etiology of drug hepatotoxicity. 13 cases （28.9 %） occurred from one month to 100 days after allo-HSCT, while 12 cases （26.7 %） occurred from 101 days to one year with the main etiology of both hepatic GVHD. 27 cases were cured and 10 were improved after treatment. 2 cases were not cured and 6 cases died from relapse of the primary disease, or else from the complication of allo-HSCT. Conclusion Hepatic dysfunction is an common complication after allo-HSCT, drug hepatotoxicity and hepatic GVHD are the major causes. The relativity between hepatic dysfunction and period after allo-HSCT is a important reference for diagnosis. It will produce desired result to choose proper therapeutic method based on etiology.