人工肝支持系統治療造血干細胞移植后并發重癥肝靜脈閉塞病_《華西醫學》

作者：

蘇毅 , 范方毅 , 易海 , 劉陽陽 , 鄧濤 , 付利 , 孫浩平 , 王譯 , 何光翠 , 賴思含 , 王淋 , 劉一嵐

成都軍區總醫院血液內科（成都，610083）;

關鍵詞：

人工肝造血干細胞移植肝靜脈閉塞病

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【摘要】　目的　了解人工肝支持系統搶救造血干細胞移植合并重癥肝靜脈閉塞病的臨床療效。　方法　對2002年1月-2010年12月因造血干細胞移植并發重癥肝靜脈閉塞病的6例患者，利用人工肝支持系統，選用血漿置換程序進行血漿置換。　結果　 6例患者經血漿置換治療后，膽紅素均明顯下降，3例最終恢復，2例因肝功能再次惡化死亡，1例死于嚴重混合性感染。　結論　人工肝支持系統搶救造血干細胞移植合并重癥肝靜脈閉塞病是一種新的嘗試，是有效和可靠的。
【Abstract】　Objective　 To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation.　Methods　 Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system.　Results　 After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections.　Conclusion　 Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.

引用本文： 蘇毅,范方毅,易海,劉陽陽,鄧濤,付利,孫浩平,王譯,何光翠,賴思含,王淋,劉一嵐. 人工肝支持系統治療造血干細胞移植后并發重癥肝靜脈閉塞病. 華西醫學, 2011, 26(12): 1787-1790. doi: 復制

1.	Senzolo M Germani G, Cholongitas E, et al. Veno occlusive disease: update on clinical management[J]. World J Gastroenterol, 2007, 13(29): 3918-3924.
2.	Kalayoglu-Besisik S, Yenerel MN, Caliskan Y, et al. Time-related changes in the incidence, severity, and clinical outcome of hepatic veno-occlusive disease in hematopoietic stem cell transplantation patients during the past 10 years[J]. Transplant Proc, 2005, 37(5): 2285-2289.
3.	Mcdonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors[J]. Hepatology, 1984, 4(1): 116-122.
4.	Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation[J]. Transplantation, 1987, 44(6): 778-783.
5.	Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation[J]. Blood, 1995, 85(11): 3005-3020.
6.	Li CK, Shing MM, Chik KW, et al. Haematopoietic stem cell transplantation for thalassaemia major in Hong Kong: prognostic factors and outcome[J]. Bone Marrow Transplant, 2002, 29(2): 101-105.
7.	Armand P, Kim H, Cutler C, et al. Prognostic impact of elevated pre-transplant serum ferritin in patients undergoing myeloablative stem eell transplantation[J]. Blood, 2007, 109(10): 4586-4588.
8.	Wadleigh M, Richardson PG, Zahrieh D, et al. Prior gcmtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation[J]. Blood, 2003, 102(5): 1578-1582.
9.	Eissner G, Multhoff G, Gerbitz A, et al. Fludarabine induces apoptosis, activation, and allogenicity in human endothelial and epithelial cells: protective effect of defibrotide[J]. Blood, 2002, 100(1): 334-340.
10.	Chalandon Y, Roosnek E, Mermillod B, et al. Prevention of veno-occlusive disease with defibrotide after allogeneie stem cell transplantation[J]. Biol Blood Marrow Transplant, 2004, 10(5): 347-354.
11.	Dignan F, Gujral D, Ethell M, et al. Prophylactic defibrotide in allogeneic stem cell transplantation: minimal morbidity and zero mortality from veno-occlusive disease[J]. Bone Marrow Transplant, 2007, 40(1): 79-82.
12.	董敏, 林曲, 吳祥元, 等. 異基因造血干細胞移植后肝靜脈閉塞病的防治效果分析[J]. 癌癥, 2008, 27(6): 646-649.
13.	Richardson PG, Soiffer RJ, Antin JH, et al. Defibrotide for the treatment of severe hepatic veno-occlusive disease and multiorgan failure after stem cell transplantation: a multicenter, randomized, dose-finding trial[J]. Biol Blood Marrow Transplant, 2010, 16(7): 1005-1017.
14.	Al Beihany A, Al Omar H, Sahovic E, et al. Successful treatment of hepatic veno-occlusive disease after myeloablative allogeneic hematopoietic stem cell ransplantation by early administration of a short course of methylprednisolone[J]. Bone Marrow Transplant, 2008, 41(3): 287-291.
15.	李蘭娟, 黃建容, 陳江華. 人工肝支持系統治療重型病毒性肝炎的研究[J]. 中華肝病雜志, 1997, 5(4): 202.

1. 　Senzolo M Germani G, Cholongitas E, et al. Veno occlusive disease: update on clinical management[J]. World J Gastroenterol, 2007, 13(29): 3918-3924.
2. 　Kalayoglu-Besisik S, Yenerel MN, Caliskan Y, et al. Time-related changes in the incidence, severity, and clinical outcome of hepatic veno-occlusive disease in hematopoietic stem cell transplantation patients during the past 10 years[J]. Transplant Proc, 2005, 37(5): 2285-2289.
3. 　Mcdonald GB, Sharma P, Matthews DE, et al. Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors[J]. Hepatology, 1984, 4(1): 116-122.
4. 　Jones RJ, Lee KS, Beschorner WE, et al. Venoocclusive disease of the liver following bone marrow transplantation[J]. Transplantation, 1987, 44(6): 778-783.
5. 　Bearman SI. The syndrome of hepatic veno-occlusive disease after marrow transplantation[J]. Blood, 1995, 85(11): 3005-3020.
6. 　Li CK, Shing MM, Chik KW, et al. Haematopoietic stem cell transplantation for thalassaemia major in Hong Kong: prognostic factors and outcome[J]. Bone Marrow Transplant, 2002, 29(2): 101-105.
7. 　Armand P, Kim H, Cutler C, et al. Prognostic impact of elevated pre-transplant serum ferritin in patients undergoing myeloablative stem eell transplantation[J]. Blood, 2007, 109(10): 4586-4588.
8. 　Wadleigh M, Richardson PG, Zahrieh D, et al. Prior gcmtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation[J]. Blood, 2003, 102(5): 1578-1582.
9. 　Eissner G, Multhoff G, Gerbitz A, et al. Fludarabine induces apoptosis, activation, and allogenicity in human endothelial and epithelial cells: protective effect of defibrotide[J]. Blood, 2002, 100(1): 334-340.
10. 　Chalandon Y, Roosnek E, Mermillod B, et al. Prevention of veno-occlusive disease with defibrotide after allogeneie stem cell transplantation[J]. Biol Blood Marrow Transplant, 2004, 10(5): 347-354.
11. 　Dignan F, Gujral D, Ethell M, et al. Prophylactic defibrotide in allogeneic stem cell transplantation: minimal morbidity and zero mortality from veno-occlusive disease[J]. Bone Marrow Transplant, 2007, 40(1): 79-82.
12. 　董敏, 林曲, 吳祥元, 等. 異基因造血干細胞移植后肝靜脈閉塞病的防治效果分析[J]. 癌癥, 2008, 27(6): 646-649.
13. 　Richardson PG, Soiffer RJ, Antin JH, et al. Defibrotide for the treatment of severe hepatic veno-occlusive disease and multiorgan failure after stem cell transplantation: a multicenter, randomized, dose-finding trial[J]. Biol Blood Marrow Transplant, 2010, 16(7): 1005-1017.
14. 　Al Beihany A, Al Omar H, Sahovic E, et al. Successful treatment of hepatic veno-occlusive disease after myeloablative allogeneic hematopoietic stem cell ransplantation by early administration of a short course of methylprednisolone[J]. Bone Marrow Transplant, 2008, 41(3): 287-291.
15. 　李蘭娟, 黃建容, 陳江華. 人工肝支持系統治療重型病毒性肝炎的研究[J]. 中華肝病雜志, 1997, 5(4): 202.

《華西醫學》

人工肝支持系統治療造血干細胞移植后并發重癥肝靜脈閉塞病

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《華西醫學》

人工肝支持系統治療造血干細胞移植后并發重癥肝靜脈閉塞病

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