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肺移植治疗造血干细胞移植后肺部慢性移植物抗宿主病的临床分析

凌国耀, 练巧燕, 李诗茵, 等. 肺移植治疗造血干细胞移植后肺部慢性移植物抗宿主病的临床分析[J]. 器官移植, 2024, 15(3): 449-455. doi: 10.3969/j.issn.1674-7445.2023258
引用本文: 凌国耀, 练巧燕, 李诗茵, 等. 肺移植治疗造血干细胞移植后肺部慢性移植物抗宿主病的临床分析[J]. 器官移植, 2024, 15(3): 449-455. doi: 10.3969/j.issn.1674-7445.2023258
Ling Guoyao, Lian Qiaoyan, Li Shiyin, et al. Clinical analysis of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(3): 449-455. doi: 10.3969/j.issn.1674-7445.2023258
Citation: Ling Guoyao, Lian Qiaoyan, Li Shiyin, et al. Clinical analysis of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation[J]. ORGAN TRANSPLANTATION, 2024, 15(3): 449-455. doi: 10.3969/j.issn.1674-7445.2023258

肺移植治疗造血干细胞移植后肺部慢性移植物抗宿主病的临床分析

doi: 10.3969/j.issn.1674-7445.2023258
基金项目: 广东省自然科学基金(2022A1515012216);广州呼吸健康研究所基金(2019GIRHZ04);广东省钟南山医学基金(ZNSA-2020013);广州呼吸健康研究院基础研究计划(202201020371)
详细信息
    作者简介:
    通讯作者:

    巨春蓉(ORCID 0000-0001-9041-874X),主任医师,教授,博士研究生导师,研究方向为终末期肺病肺移植术前评估与术后并发症诊治,Email:juchunrong@126.com

  • 中图分类号: R617, R55

Clinical analysis of lung transplantation for lung chronic graft-versus-host disease after hematopoietic stem cell transplantation

More Information
  • 摘要:   目的   探讨肺移植治疗造血干细胞移植(HSCT)后肺部慢性移植物抗宿主病(cGVHD)的疗效。  方法  回顾性分析因肺部cGVHD接受肺移植治疗的12例患者的临床资料。分析患者的术前临床表现及累及器官,对比肺移植前后肺功能,分析患者肺移植术后生存情况。  结果  11例患者因原发血液系统恶性疾病行HSCT,其中白血病9例、骨髓增生异常综合征1例、淋巴瘤1例。1例因系统性红斑狼疮行HSCT。12例cGVHD患者中,8例同时累及皮肤,5例同时累及口腔,4例同时累及胃肠道,3例同时累及肝脏。12例患者肺移植术前均存在严重肺部cGVHD导致的呼吸衰竭,其中表现为Ⅱ型呼吸衰竭9例;表现为Ⅰ型呼吸衰竭3例。肺移植手术方式包括右肺移植2例、左肺移植2例、双肺移植8例。从接受HSCT到接受肺移植的间隔时间为75(19~187)个月。截至投稿日,随访时间为18(7~74)个月,其中10例患者存活,1例于术后22个月死于重症肝炎,另外1例于术后6个月死于消化道大出血,存活患者均未发现原发病复发。  结论  肺移植是治疗HSCT后肺部cGVHD的一种有效手段,可延长患者生存时间并提高生活质量。

     

  • 图  1  纳入及排除标准

    Figure  1.  Inclusion and exclusion criteria

    图  2  HSCT后肺部并发症影像学表现

    注:A图为BOS影像学表现,双肺透亮度增加、容积增大、双下肺局部存在支气管扩张、支气管壁增厚、气胸、纵隔气肿等;B图为ILD影像学表现,双肺多发的圆形或不规则斑点状高密度影、肺实质内纤维化、肺内网状影、胸膜下线影、肺泡壁增厚等;C图为PPFE影像学表现,以肺尖为主的胸膜下区域的纤维化,同时伴有胸膜增厚及胸膜下线影。

    Figure  2.  Imaging manifestations of pulmonary complications after HSCT

    图  3  肺移植前后肺功能对比

    注:A图为患者FEV1%pred;B图为患者FVC%pred;C图为患者弥散功能。

    Figure  3.  Comparison of lung function before and after lung transplantation

    表  1  12例接受肺移植患者的临床资料

    Table  1.   Clinical data of 12 patients receiving lung transplantation

    例序 性别 年龄(岁) 术前BMI
    (kg/m2
    原发病 肺移植指征 HSCT日期 骨髓
    配型
    累及器官 肺移植
    日期
    术式 术后情况 现生存情况 6分钟步行
    距离
    (m)
    1 20 16.4 ALL BOS 2018年7月30日 全相合 肺、皮肤、
    口腔、肝脏、胃肠道
    2020年3月19日 双肺移植 顺利出院 良好 404
    2 35 15.8 AML BOS 2006年6月 全相合 肺、皮肤、
    肝脏
    2021年8月9日 双肺移植 顺利出院 良好 376
    3 19 17.0 AML BOS 2018年3月29日 半相合 肺、肝脏 2021年8月14日 双肺移植 顺利出院 良好 650
    4 37 11.7 MDS BOS 2017年6月 全相合 肺、眼睛 2021年11月23日 双肺移植 顺利出院 良好 460
    5 39 14.8 ALL BOS 2014年7月 全相合 肺、口腔 2021年12月15日 双肺移植 顺利出院 良好 330
    6 33 24.7 ALL BOS 2006年7月 全相合 肺、皮肤、
    口腔、胃肠道
    2022年2月12日 双肺移植 顺利出院 良好 488
    7 38 14.9 ALL BOS 2006年6月 全相合 肺、口腔 2022年2月9日 左肺移植 顺利出院 良好 325
    8 39 13.9 AML ILD 2013年5月 全相合 肺、胃肠道、皮肤 2022年3月10日 右肺移植 顺利出院 术后6个月死亡
    9 31 15.6 ALL BOS 2017年7月 全相合 肺、口腔、
    眼睛、皮肤
    2022年10月16日 双肺移植 顺利出院 良好 480
    10 42 14.1 ALL BOS 2019年7月26日 半相合 肺、眼睛、
    指甲、皮肤、
    胃肠道
    2022年9月21日 双肺移植 顺利出院 良好 457
    11 41 21.1 SLE ILD 2007年4月8日 半相合 肺、皮肤 2017年3月11日 右肺移植 顺利出院 良好 400
    12 29 17.2 淋巴瘤 PPFE 2011年9月14日 半相合 肺、皮肤 2016年3月5日 左肺移植 顺利出院 术后22个月死亡
     注:①ALL为急性淋巴细胞白血病。
       ②AML为急性髓系白血病。
       ③MDS为骨髓增生异常综合征。
       ④—为无数据。
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  • 收稿日期:  2023-12-28
  • 网络出版日期:  2024-03-25
  • 刊出日期:  2024-05-15

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