肝移植后发生移植物抗宿主病受者的骨髓象特征

目的 探讨原位肝移植术后发生移植物抗宿主病(GVHD)受者的骨髓象特征.方法 回顾性分析3例原位肝移植术后发生GVHD受者的临床资料.对3例受者的骨髓细胞学、血常规及血液生化等进行了检查,并对受者骨髓象及造血系统功能的改变进行了分析;采用聚合酶链(PCR)技术检测供、受者16个位点的短串联重复序列(STR),对1例受者的嵌合体状况进行了分析.结果 3例受者均出现发热、皮疹、腹泻等典型的GVHD临床表现;全血细胞进行性减少,骨髓增生低下,造血功能发生严重衰竭;血常规及血液生化检查显示,受者的白细胞、血小板和网织红细胞等大量减少;1例受者在移植术后第35天被证实存在供、受者问的D8S1179、D21S11两位点的嵌合体.最终1例受者经及时治疗后恢复造血功能,另2例受者死亡.结论 肝移植术后发生移植物抗宿主病可诱导受者骨髓造血功能衰竭.

Characteristics of acute hemopoietic failure caused by GVHD after orthotopic liver transplantation

Objective To study the characteristics of acute hematopoietic failure caused by GVHD after orthotopic liver transplantation (OLT). Methods The clinical data of 3 recipients with pathologically confirmed GVHD following liver transplantation were retrospectively analyzed. Lymphocyte macrochimerism in one patient was detected through DNA-STR with 16 STR loci. The marrow cells, blood cells and some biochemistry markers were also tested. The change of bone marrow smear and function of hematopoietic system were investigated. Results Three Patients typically developed fever, skin rash, diarrhea, pancytopenia and acute bone hematopoietic failure occurred. One patient was positive for macrochimerism by the presence of STR loci DSS1179 and D21S11 35 days after OLT. Two patients died of hemorrhage and exhaustion. One patient recovered hematopoietie function.Conclusion GVHD after OLT might cause acute bone marrow hematopoietic failure.