骨髓移植术后急性移植物抗宿主病肝酶学的异常特点

目的 探讨异基因造血干细胞移植(allo-HSCT)后急性移植物抗宿主病(aGVHD)组与非aGVHD组肝酶学变化特点.方法 回顾性分析北京大学人民医院allo-HSCT患者肝脏酶学的变化情况及与aGVHD发生的关系.结果 371例接受allo-HSCT患者中共有158例(41.6%)发生Ⅰ～Ⅳ度aGVHD;中位时间为第29.5天.未发生aGVHD组,ALT、AST、GGT、LDH升高的中位时间均在移植后20 d之内,明显早于发生aGVHD组.发生aGVHD组,AST峰值明显升高,其余肝酶学峰值差异无统计学意义;发生aGVHD组,AST、GGT、LDH持续时间均显著长于未发生aGVHD组,ALT、ALP持续时间无差异;ALT、AST、ALP、LDH升高组,aGVHD发生的百分比明显高于未升高组,但只有ALT、LDH升高进入logistic模型;单纯ALT、LDH升高诊断aGVHD敏感度及准确性均较差;若为移植24 d后ALT及LDH同时升高且持续时间均超过22 d,则敏感度及准确性均较好.结论 肝酶学升高,尤其是ALT、LDH的升高与aGVHD发生相关,但作为aGVHD的诊断指标准确性欠佳;在排除药物性肝损伤的影响下,结合肝酶学的动力学特点,肝酶学的升高在诊断aGVHD仍有一定意义.

Characteristics of fiver enzyme abnormalities in acute graft-versus-host disease after bone marrow transplantation

Objective To investigate the characteristics of liver enzyme between acute graft-versushost disease (aGVHD) and non-aGVHD groups after allogeneic hematopoietie stem cell transplantation (allo-HSCT). Methods The liver enzyme data of patients with or without aGVHD was analyzed. Results Among the 371 patients, 158 developed aGVHD(41.6%) with a median time of 29. 5 d. In non-aGVHD group, the median elevating times of ALT, AST, GGT, LDH were all ≤ 20 d after transplantation, which were significantly earlier than those of aGVHD group. The peak value of AST was much higher in aGVHD group, but the remaining liver enzyme showed no significant difference. In aGVHD group, the duration of AST, GGT and LDH was significantly longer than the non-occurrence of aGVHD group, but ALT and ALP showed no difference in duration. In ALT, AST, ALP and LDH elevating group, the occurrence rate of aGVHD was significantly higher, but only ALT and LDH elevation could enter logistic regression model. The sensitivity and veracity of ALT or LDH elevating only were not very good for the diagnosis of aGVHD, but if ALT and LDH beth elevated after day 24 and persisted more than 22 d, the sensitivity and veracity were better. Conclusions The change of liver enzyme is common in allo-HSCT and associates with the occurrence of aGVHD, and the liver enzyme elevating only may not be a good diagnostic index of aGVHD. If the dynamic characteristics of liver enzyme is taken into account and the effect of drug-induced liver injury could be excluded, the elevation of liver enzyme still have the diagnostic value of aGVHD.