Chinese Journal of Tissue Engineering Research ›› 2019, Vol. 23 ›› Issue (13): 2042-2048.doi: 10.3969/j.issn.2095-4344.1686
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Wei Yuanfeng, Wei Zhongling, Yang Yuqiong, Qi Jing, Yan Jiawei, Huang Dongping
Revised:
2019-01-16
Online:
2019-05-08
Published:
2019-05-08
Contact:
Huang Dongping, Chief physician, Master’s supervisor, Department of Hematology, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui Province, China
About author:
Wei Yuanfeng, Master candidate, Department of Hematology, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui Province, China.
Wei Zhongling, Master, Associate chief physician, Department of Hematology, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui Province, China.
Wei Yuanfeng and Wei Zhongling contributed equally to this work.
Supported by:
the Natural Science Foundation of Anhui Provincial Education Department, No. KJ2016SD58 (to HDP); the Key Scientific Research Project of Wannan Medical College, No. WK2018ZF09 (to WZL)
CLC Number:
Wei Yuanfeng, Wei Zhongling, Yang Yuqiong, Qi Jing, Yan Jiawei, Huang Dongping. Allogeneic hematopoietic stem cell transplantation for severe aplastic anemia in 10 cases[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(13): 2042-2048.
2.4 并发症 2.4.1 移植物抗宿主病 共有4例发生急性移植物抗宿主病,中位发生时间为移植后26.5(13-120) d,其中Ⅱ度急性移植物抗宿主病2例,Ⅳ度急性移植物抗宿主病2例。发生Ⅳ度急性移植物抗宿主病的患者均为单倍体相合异基因造血干细胞移植。截止到随访日期,无患者发生慢性移植物抗宿主病。 2.4.2 感染 上呼吸道感染3例;肺部感染6例,其中2例系肺部细菌、真菌混合性感染(例8、例9);败血症4例,致病菌为大肠埃希菌2例、肺炎克雷伯菌2例;尿路感染3例;肛周软组织感染1例;皮肤软组织感染1例;巨细胞病毒血症9例;EB病毒血症6例,其中2例(例4、例8)同时伴有浅表淋巴结及肝脾肿大,临床疑诊为EB病毒相关淋巴组织增殖性疾病(EBV-PTLD),给予利妥昔单抗375 mg/(m2•周),2-4次治疗后EB病毒转阴。 2.4.3 其他并发症 10例患者中出血性膀胱炎3例,其中同胞全合异基因造血干细胞移植组1例,单倍体相合异基因造血干细胞移植组2例,予以水化、碱化、强迫利尿等治疗后痊愈;亚甲炎1例;甲减1例。所有患者移植过程中均未发生肝静脉闭塞综合征以及血清病。 2.4.4 移植相关死亡 例9移植后并发胰腺功能损害及心功能不全,在积极对症处理后症状好转;移植后24 d并发肺部混合性感染,移植后27 d患者并发Ⅳ度急性移植物抗宿主病;经过积极抗感染、甲强龙、他克莫司、间充质干细胞输注、CD25单抗等治疗,症状有所控制,之后因患者坚决放弃治疗,于移植后79 d死亡。例10患者移植后并发肺部感染、血栓性微血管病,家属放弃治疗,于移植后85 d死亡。 2.5 疗效及随访 10例患者全部获得稳定植入及造血重建。中位随访时间7.3(2.5-49.7)个月,同胞全合异基因造血干细胞移植组7例患者全部存活,3例进行单倍体相合异基因造血干细胞移植患者1例存活,总的生存率为80%,见图2。"
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