异基因外周血造血干细胞移植后迟发性非感染性肺部合并症临床研.docVIP

异基因外周血造血干细胞移植后迟发性非感染性肺部合并症临床研 　 作者：张翼鷟, 高春记,张伯龙, 达万明,韩晓蘋, 李红华,靖彧, 黄文荣, 薄剑, 王书红,朱海燕，靳海杰, 于力 【摘要】 　　本研究探讨异基因外周血造血干细胞移植(alloPBSCT)后迟发性非感染性肺部合并症（lateonset noninfectious pulmonary complications, LNIPC）的发生、危险因素、预后及治疗方法。对70例alloPBSCT患者的临床资料进行了回顾性分析。结果发现：在存活超过3个月的63例患者中，9例发生了LNIPC，发生率为14.3%，其中5例并发感染, 由LNIPC导致死亡者4例。移植时疾病处于晚期及慢性广泛性GVHD与LNIPC的发生显著相关；性别、年龄、预处理方案的选择、HLA相合程度及GVHD的预防等均与该并发症的发生无明显相关。结论：移植后定期监测胸部CT、肺功能等甚为必要，对LNIPC早期诊断者采用强的松复合或不复合环孢菌素A治疗，其中多数患者能获缓解。 【关键词】 异基因外周血造血干细胞移植 迟发性非感染性肺部并发症 移植物抗宿主病 　　Lateonset Noninfectious Pulmonary Complications after Allogeneic Peripheral Blood Stem Cell Transplantation Abstract The aim of study was to explore the incidence, risk factors, outcome and efficacious treatment of lateonset noninfectious pulmonary complications (LNIPC) after allogeneic peripheral blood stem cell transplantation (alloPBSCT). Seventy patients received alloPBSCT were analyzed retrospectively. The results showed that 9 out of 63 patients surviving more than 3 months occurred lateonset noninfectious pulmonary complications (14.3%). Five out of the 9 patients developed secondary pulmonary infections. In 4 patients, LNIPC caused death directly. Advanced stage of disease at transplantation and extensive chronic graftversushost disease (GVHD) happened in association with LNIPC. However, other transplantationrelated factors including age at transplantation, gender of patient, conditioning regimen, HLA matching and GVHD prophylaxis were not significantly correlated with the incidence of LNIPC. It is concluded that performing pulmonary function test (PFT) and thoracic computer tomography should be taken routinely after transplantation. Most patients who get correct and early diagnosis for LNIPC will show a positive response to prednisone with or without CsA. Key words allogeneic peripheral blood stem cell transplantation； lateonset noninfectious pulmonary complications； graftversushost disease 迟发性非感染性肺部合并症（lateonset noninfectious pulmonary complications,