摘要
目的探讨自体外周血造血干细胞移植(APBSCT)治疗系统性红斑狼疮(SLE)的可行性及临床效果。方法对8例女性难治性SLE病人进行APBSCT。采集的干细胞的单个核细胞计数平均为1.6×108/kg[(0.07～2.6)×108/kg]。预处理方案为环磷酰胺(50mg·kg-1·d-1,-5～-2d)静脉滴注及兔抗人淋巴细胞免疫球蛋白(10mg·kg-1·d-1,-3～-1d)静脉滴注。从移植前后皮肤红斑的变化,尿的改变,SLE相关的免疫指标的变化,移植后造血重建情况,移植的并发症等方面进行评价。结果8例病人均获得成功植入,外周血白细胞总数>1.0×109/L的平均时间为9.5d,中性粒细胞计数>0.5×109/L的平均时间为10d,白细胞总数恢复正常的平均时间为14d,血小板计数>50×109/L的平均时间为30d,血红蛋白含量平均在移植后第28天升至100g/L。移植后SLE临床症状均消失,尿蛋白转阴,自身抗体大部分转阴。移植相关并发症中,均出现血清病样预处理反应,2例出现严重的低血压;4例有出血性膀胱炎;2例出现败血症;4例发生霉菌感染;2例发生间质性肺炎。随访时间2个月～2.5年。结论APBSCT治疗SLE有较好的近期疗效,但观察病例及时间有限,远期疗效还需更长时间的观察。对药物治疗难以奏效的SLE病例,该法不失为一种更佳的选择。
Objective To study the therapeutic effect and feasibility of autologous peripheral blood stem cell transplantation (APBSCT) on systemic lupus erythematosus (SLE). Methods Eight cases of female patients with refractory SLE received APBSCT. The average mononuclear cell counts of stem cell in collective productions was 1.6×108/kg. The pretreatment regimen was intravenous injection of cyclophosphamide (50mg·kg-1·d-1, -5～-2 d) and rabbit-against human lymphocyte immunoglobulin (10 mg·kg-1·d-1, -3～-1 d). The therapeutic effect was evaluated by the change of skin erythema, urine protein, autoantibody, hematopoietic reconstitution and transplantation related complications. Results All of the cases had been successfully engrafted. The average time for the peripheral leucocyte count to reach 1.0×109/L was 9.5 days and 4×109/L 14 days. It needed 10 days for neutrophils to get to 0.5×109/L, 30 days for platelets to get to 50×109/L and 28 days for hemoglobin to 100 g/L. The skin erythema disappeared, the urine protein decreased to normal level and the autoantibodies in most of the patients bacame negative. Serum sickness-like pretreatment response presented in 8 patients, severe hypotension in 2 patients, hemorrhagic cystitis in 4 patients, septticemia in 2 patients, fungal infection in 4 patients and interstitial pneumonia in 2 patients. The follow-up period was from 2 months to 2.5 years. Conclusion The APBSCT for SLE has got remarkable effects in short-term observation, but the long-term effect should be followed up. The result of this study suggests that APBSCT is a good option for refractory SLE.
出处
《中华风湿病学杂志》
CAS
CSCD
2005年第1期28-30,共3页
Chinese Journal of Rheumatology
