上海交通大学学报（医学版）

上海交通大学学报（医学版）

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5例异基因外周血造血干细胞移植术后特发性肺炎诊治体会

李肃，杨隽，姜杰玲，蔡宇，王椿，白海涛   

  1. 上海交通大学附属第一人民医院血液科， 上海 200080
  • 出版日期:2016-01-28 发布日期:2016-02-26
  • 通讯作者: 白海涛, 电子信箱: baihaitao123456@sohu.com。
  • 作者简介:李肃（1978—）， 男， 主治医师， 硕士; 电子信箱: lisuabcd@126.com。
  • 基金资助:

    上海市卫生和计划生育委员会课题（20124250)

Experience of diagnosis and treatment of five patients with idiopathic pneumonia after allogeneic hematopoietic stem cell transplantation

LI Su, YANG Jun, JIANG Jie-ling, CAI Yu, WANG Chun, BAI Hai-tao   

  1. Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University， Shanghai 200080, China
  • Online:2016-01-28 Published:2016-02-26
  • Supported by:

    Foundation of Shanghai Municipal Commission of Health and Family Planning, 20124250。

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摘要：

目的 探讨异基因造血干细胞移植(HSCT)患者术后并发特发性肺炎（IPS)的临床特征及治疗转归。方法 回顾性分析2013年1月至2014年12月上海交通大学附属第一人民医院血液科70例HSCT患者中5例诊断IPS患者的临床特点、肺功能表现、影像学表现和治疗经过。结果 5例IPS患者临床表现均有咳嗽、咳痰，部分伴有发热、胸闷及低氧血症，均伴有不同程度急慢性移植物抗宿主病（GVHD）表现。肺CT表现为以多个肺野散在分布的斑片影伴毛玻璃影为主要特点。3例患者肺功能表现为阻塞性为主的混合性通气功能障碍，另外2例表现为弥散性通气功能障碍；所有患者在接受激素治疗后症状改善明显，影像学大部分明显吸收好转。结论 异基因HSCT术后IPS具有特殊的影像学和肺功能表现，多伴有GVHD临床表现，早期给予包含激素在内的综合治疗往往能取得较好效果。

关键词: 异基因造血干细胞移植, 特发性肺炎, 肺功能, 移植物抗宿主病, 肺CT

Abstract:

Objective To investigate the clinical characteristics and treatment outcomes of patients with idiopathic pneumonia syndrome (IPS) after allogenetic hematopoietic stem cell transplantation (HSCT). Methods Clinical characteristics, manifestations of lung function and imaging, and treatment processes of 5 patients with IPS from 70 patients undergoing HSCT in the Department of Hematology of the General Hospital Affiliated to Shanghai Jiao Tong University from January 2013 to December 2014 were retrospectively analyzed. Results All patients with IPS had the clinical manifestations of cough, expectoration, and different degrees of acute and chronic graft versus host disease (GVHD). Some of them had the clinical manifestations of fever, chest tightness, and hypoxemia. Lung CT showed multiple patchy shadows scattered in the lung field featured by accompanying ground glass shadows. The manifestation of pulmonary function of three patients was obstruction based mixed ventilation dysfunction, while the manifestation of other two patients was diffuse ventilation dysfunction. Symptoms of all patients were remarkably alleviated after glucocorticoid therapy. Imaging results showed most lesions were significantly absorbed. Conclusion IPS has special manifestations of imaging and pulmonary function after allogeneic HSCT and the clinical manifestations of GVHD commonly accompanies. Early comprehensive treatment including administration of glucocorticoid can obtain a satisfactory therapeutic effect.

Key words: allogeneic hematopoietic stem cell transplantation, idiopathic pneumonia syndrome, pulmonary function, graft versus host disease, lung CT