摘要
目的通过分析肾移植后发生移植物抗宿主病(graft-versus-host disease,GVHD)的临床特点及诊疗经过,探讨肾移植术后GVHD的诊疗措施。方法回顾性分析本院收治的1例罕见肾移植术后GVHD患者的诊疗过程。患者肾移植术后25 d因全身皮肤破损,伴发热、呕血、黑便入院治疗,高度怀疑GVHD,为明确诊断,于皮损处行皮肤组织活检,并停用免疫抑制剂,予以小剂量甲泼尼龙冲击治疗,免疫球蛋白联合胸腺肽提升免疫力,抗感染、营养支持,白细胞、血小板减少时予以集落刺激因子、血浆、血小板,加强皮肤护理及持续床边超滤等治疗。结果患者皮肤组织活检病理报告提示:皮肤表皮基底层细胞局灶空泡变性,表皮内可见嗜酸性坏死,真皮层淋巴细胞浸润性GVHD改变,结合患者临床症状,从而确诊为肾移植术后GVHD。经上述治疗患者病情一度出现好转,治疗方案起到一定的效果。但患者最终死于失血性休克以及多脏器功能衰竭。结论 GVHD在肾移植患者中极其罕见,临床表现不典型,导致诊断常被延迟,且GVHD病情进展迅速,预后差。临床工作中,一旦移植术后患者出现不明原因的发热、皮疹、腹泻、骨髓抑制等临床表现应高度怀疑GVHD,患者皮肤组织病理活检是可行的诊断GVHD的方法,同时给予小剂量甲泼尼龙冲击治疗,免疫球蛋白联合胸腺肽提升免疫力等药物治疗或许可获得更多受益。
Objective To analyze the clinical characteristics and treatment of graft-versushost disease(GVHD)after renal transplantation,and to explore the diagnosis and treatment of GVHD after renal transplantation.Methods A rare case of GVHD after renal transplantation in our hospital was retrospectively analyzed.The patient was admitted to hospital 25 days after kidney transplantation because of skin damage,fever,hematemesis and blackstool.He was highly suspicious of GVHD.In order to make a definite diagnosis,skin biopsy was performed at the lesion.Immunosuppressive agents were discontinued and low dose methylprednisolone was given.Immunoglobulin combined with thymosin enhanced immunity and anti-infection.Nutritional support,colony stimulating factor,plasma transfusion,platelet transfusion,skin care and continuous bedside ultrafiltration were given for leukopenia and thrombocytopenia.Results Pathological report of skin biopsy showed that the basal layer cells of skin epidermis had vacuolar degeneration,eosinophilic necrosis in epidermis,infiltrative GVHD changes of lymphocyte in dermis,combined with the clinical symptoms of patients,GVHD after kidney transplantation was diagnosed.After the above treatment,the patient’s condition once improved,and the treatment program played a certain role.But the patient eventually died of hemorrhagic shock and multiple organ failure.Conclusion GVHD is extremely rare in kidney transplantation patients,its clinical manifestations are atypical,which leads to delayed diagnosis,rapid progression of GVHD and poor prognosis.In clinical work,when the patients have fever,rash,diarrhea and bone marrow depression of unknown causes after transplantation,GVHD should be highly suspected.Skin biopsy is a feasible method to diagnose GVHD.At the same time,low dose methylprednisolone bolus therapy should be given.Immunoglobulin combined with thymosin can enhance immunity.Drug therapy such as Li may benefit more.
作者
林凯远
刘相艳
庄莉
辛海亮
寿张飞
郑小平
Lin Kaiyuan;Liu Xiangyan;Zhuang Li;Xin Hailiang;Shou Zhangfei;Zheng Xiaoping(Shulan( Hangzhou) Hospital, Hangzhou 310000, Zhejiang,China)
出处
《实用器官移植电子杂志》
2019年第5期367-369,共3页
Practical Journal of Organ Transplantation(Electronic Version)
基金
浙江省医药卫生科技计划项目(2016KYA073)
关键词
肾移植
移植物宿主病
Kidney transplantation
Graft-versus-host diseas
