亲缘间异基因造血干细胞移植后急性移植物抗宿主病的发病特点、预防与治疗的临床分析

发布时间：2018-06-20 02:13

本文选题：急性白血病 + 外周血造血干细胞移植　；参考：《新疆医科大学》2010年硕士论文

【摘要】：目的:临床回顾性分析不同类型异基因外周血造血干细胞移植(allogeneic peripheral blood stem cell transplantation,allo-PBSCT)术后急性移植物抗宿主病发生特点,评价甲强龙+环孢素A或联合其他药物治疗方案对不同分级、部位急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)的疗效。方法:对我院2004年1月至2009年12月140例行allo-PBSCT患者进行aGVHD发生及治疗情况分析。其中HLA全相合移植78例,单倍体相合移植62例。GVHD预防:全相合采用环孢素A(CsA)+霉酚酸酯(MMF)+甲氨蝶呤(MTX)+糖皮质激素方案;单倍体患者据病情增加MMF及糖皮质激素使用剂量及时间、加用抗胸腺细胞球蛋白(ATG)、CD25单克隆抗体。急性GVHD诊断和分级采用国际公认标准。比较全相合与单倍体移植aGVHD发生有无差异,观察不同时间、部位aGVHD的分布情况。采用甲强龙(MP)+CsA为aGVHD的一线治疗方案,分析不同相合、分级、部位aGVHD对MP+CsA治疗的有效率,无效者加用CD25单克隆抗体后效果。结果:在积极预防的情况下,aGVHD总发生率为35.0%,Ⅲ-Ⅳ度aGVHD为7.14%,均明显减低。全相合组aGVHD发生率(21.8%)低于单倍体组(51.6%)(P0.05),但Ⅲ~Ⅳ度aGVHD的发生率两组之间无统计学差异(P0.05)。MP+CsA治疗总有效率为83.93%,其中完全缓解率为62.5%,部分缓解率为21.43%,单倍体与全相合组有效率无统计学差异(P0.05);对Ⅰ-Ⅱ度aGVHD效果优于Ⅲ-Ⅳ度(P0.05);皮肤型、肠道型、肝脏型有效率无统计学差异(P0.05),但均优于广泛型(P0.05)。对于MP+CsA耐药的患者,CD25单克隆抗体具有较好的疗效。结论:在积极预防的基础上,aGVHD发生率减低,严重程度减轻;单倍体相合移植轻度aGVHD明显增高,但中重度aGVHD与全相合移植相似;MP+CsA可以有效的治疗单脏器aGVHD;对于累及多脏器单用甲强龙治疗无效者,加用CD25单克隆抗体为有效的治疗方法。
[Abstract]:Objective: to analyze the characteristics of acute graft-versus-host disease after different types of allogeneic peripheral blood hematopoietic stem cell transplantation (allogeneic peripheral blood stem cell transplantation, allo-PBSCT), and evaluate the treatment of acute graft-versus-host disease with different classification and location by the treatment of methylprednisolone + cyclosporin A or other drugs. The effect of (acute graft-versus-host disease, aGVHD). Methods: analysis of the occurrence and treatment of aGVHD in 140 cases of allo-PBSCT patients in our hospital from January 2004 to December 2009. Among them, there were 78 cases of HLA complete transplantation, 62 cases of.GVHD prevention with haploid allograft transplantation: all the combination of cyclosporine A (CsA) + mycophenolate mofetil (MMF) + methotrexate (MTX) + glucocorticoid Hormone regimen; haploid patients increased MMF and glucocorticoid use dosage and time, combined with anti thymus globulin (ATG), CD25 monoclonal antibody. Acute GVHD diagnosis and classification adopted internationally accepted standards. Compare the difference between total and haploid aGVHD, and observe the distribution of aGVHD at different time and location. Using MP +CsA as the first-line treatment of aGVHD, we analyzed the efficiency of different compatibility, grading, and site aGVHD for MP+CsA treatment. The effect of CD25 monoclonal antibody was added to the invalid. Results: the total incidence of aGVHD was 35%, and the aGVHD of grade III to IV was 7.14%, and the incidence of aGVHD (21.8%) in the full phase group was lower than that of the group. The haploid group (51.6%) (51.6%) (P0.05), but there was no statistical difference between the two groups (P0.05), the total effective rate of.MP+CsA treatment was 83.93%, the total remission rate was 62.5%, the partial remission rate was 21.43%, the haploid and the total compatibility group had no statistical difference (P0.05), and the effect on I to II degree aGVHD was superior to the degree of III - IV (P0.05) and skin. Type, intestinal type and liver type had no statistical difference (P0.05), but all were superior to broad type (P0.05). For patients with MP+CsA resistance, CD25 monoclonal antibody had good curative effect. Conclusion: on the basis of active prevention, the incidence of aGVHD was reduced and the severity of aGVHD was reduced; the mild aGVHD increased significantly in haploid allograft, but moderate to severe aGVHD and whole Similar transplantation is similar; MP+CsA can be effective in the treatment of single organ aGVHD, and the use of CD25 monoclonal antibodies is an effective treatment for those who are not effective in the treatment of multiple viscera alone with methylprednisolone.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R392

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