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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (12): 58-62.doi: 10.6040/j.issn.1671-7554.0.2022.0386

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9例儿童异基因造血干细胞移植后闭塞性细支气管炎综合征的临床特征

梁子婷1*,许长娟1*,曾荣1,张锦涛1,曾庆师2,董亮1,3   

  1. 1. 山东大学 山东省千佛山医院呼吸与危重症医学科, 山东 济南 250014;2. 山东第一医科大学第一附属医院(山东省千佛山医院)放射科, 山东 济南 250014;3.山东第一医科大学第一附属医院(山东省千佛山医院)呼吸与危重症医学科, 山东省呼吸疾病研究所, 山东 济南 250014
  • 发布日期:2022-12-01
  • 通讯作者: 董亮. E-mail:dl5506@126.com*共同第一作者.
  • 基金资助:
    山东省重点研发计划(2021SFGC0504);山东省自然科学基金联合基金(ZR2021LSW015)

Clinical characteristics of bronchiolitis obliterans syndrome after allogeneichematopoietic stem cell transplantation in 9 children

LIANG Ziting1*, XU Changjuan1*, ZENG Rong1, ZHANG Jintao1, ZENG Qingshi2, DONG Liang1,3   

  1. 1. Department of Respiratory, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, Shandong, China;
    2. Department of Radiology, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong, China;
    3. Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University &
    Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory, Jinan 250014, Shandong, China
  • Published:2022-12-01

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摘要： 目的 分析儿童异基因造血干细胞移植(allo-HSCT)术后并发闭塞性细支气管炎综合征(BOS)的临床特征。 方法 收集2014年8月至2021年3月于山东省千佛山医院住院行allo-HSCT后确诊BOS的9例患儿的病历资料,回顾性分析9例患儿的临床症状、胸部高分辨CT、肺功能、诊断以及治疗。 结果 9例患儿allo-HSCT术后出现BOS的时间为(9.3±4.4)个月,主要临床表现为干咳、气喘。BOS在胸部高分辨CT中的主要表现为支气管壁增厚、支气管扩张和马赛克征等。肺功能改变以阻塞性通气功能障碍同时伴有弥散功能下降为主。allo-HSCT后BOS的治疗主要以免疫抑制剂和糖皮质激素为主,9 例患儿治疗后均好转。 结论 BOS是儿童行allo-HSCT治疗后发生在肺部的排异表现,其临床表现、肺功能以及胸部CT表现缺乏特异性。BOS会造成肺部不可逆性损害,移植后患儿需规律行肺功能检查以早诊断、早治疗。

关键词: 异基因造血干细胞移植, 儿童, 闭塞性细支气管炎综合征, 临床特征, 诊断

Abstract: Objective To analyze the clinical characteristics of bronchiolitis obliterans syndrome(BOS)in children who had received allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods The clinical data of 9 children with BOS after allo-HSCT treated in Shandong Provincial Qianfoshan Hospital during Aug. 2014 and Mar. 2021 were retrospectively analyzed, including the clinical characteristics, chest imaging features, pulmonary function, diagnosis and treatment. Results The onset of BOS after allo-HSCT was(9.3±4.4)months. Cough and wheezing were the main clinical features. The main manifestations of BOS in the high resolution CT(HRCT)were bronchiectasis, bronchial wall thickening and mosaic sign. Pulmonary function was mainly characterized with obstructive ventilation dysfunction and decreased diffusion function. The rnain treatment were immunosuppressive therapy and corticosteroids. All 9 children improved after treatment. Conclusion BOS is a pulmonary rejection manifestation in children after allo-HSCT. There are no specific clinical manifestations, pulmonary function tests and HRCT findings. Children undergoing transplantation need regular lung function examinations for early diagnosis and treatment.

Key words: Allogeneic hematopoietic stem cell transplantation, Children, Bronchiolitis obliterans syndrome, Clinical features, Diagnosis

中图分类号: 

  • R562.21
[1] Grønningsæter IS, Tsykunova G, Lilleeng K, et al. Bronchiolitis obliterans syndrome in adults after allogeneic stem cell transplantation pathophysiology, diagnostics and treatment [J]. Expert Rev Clin Immunol, 2017, 13(6): 553-569.
[2] Majhail NS. Long-term complications after hematopoietic cell transplantation [J]. Hematol Oncol Stem Cell Ther, 2017, 10(4): 220-227.
[3] Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report [J]. Biol Blood Marrow Transplant, 2015, 21(3): 389-401.
[4] Martin PJ, Lee SJ, Przepiorka D, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: VI. The 2014 Clinical Trial Design Working Group Report [J]. Biol Blood Marrow Transplant, 2015, 21(8): 1343-1359.
[5] 高凌云, 曹照龙. 异基因干细胞移植后闭塞性细支气管炎综合征肺功能分析[J]. 中国医刊, 2011, 46(9): 54-56.
[6] 柴晶晶, 柳涛, 蔡柏蔷, 等. 造血干细胞移植后闭塞性细支气管炎综合征的临床特点[J]. 中华结核和呼吸杂志, 2017, 40(7): 504-508.
[7] 游红亮, 丁艳杰, 陈娇, 等. 儿童造血干细胞移植后闭塞性细支气管炎综合征7例临床分析[J]. 中华实用儿科临床杂志, 2022, 37(10): 774-777.
[8] Wieringa J, van Kralingen KW, Sont JK, et al. Pulmonary function impairment in children following hematopoietic stem cell transplantation[J]. Pediatr Blood Cancer, 2005, 45(3): 318-323.
[9] Bergeron A, Belle A, Chevret S, et al. Combined inhaled steroids and bronchodilatators in obstructive airway disease after allogeneic stem cell transplantation [J] Bone Marrow Transplant, 2007, 39(8): 547-553.
[10] Bergeron A. Late-onset noninfectious pulmonary complications after allogeneic hema-topoietic stem cell transplantation [J]. Clin Chest Med, 2017, 38(2): 249-262.
[11] Kemp R, Pustulka l, Boerner G, et al. Relationship between FEV(1)decline and mortality in patients with bronchiolitis obliterans syndrome-a systematic literature review [J]. Respir Med, 2021, 188: 106608. doi: 10.1016/j.rmed.2021.106608.
[12] Hildebrandt GC, Fazekas F, Lawitschka A, et al. Diagnosis and treatment of pulmonary chronic GVHD: report from the consensus conference on clinical practice in chronic GVHD [J]. Bone Marrow Transplant, 2011, 46(10): 1283-1295.
[13] Gunn ML, Godwin JD, Kanne JP, et al. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation [J]. J Thorac Imaging, 2008, 23(4): 244-250.
[14] 陈颖瑶. 异基因造血干细胞移植相关闭塞性细支气管炎综合征回顾性分析[D]. 广州: 南方医科大学, 2021.
[15] 庄娟. 异基因造血干细胞移植后闭塞性细支气管炎综合征临床分析[D]. 苏州: 苏州大学, 2019.
[16] Bankier AA, Van Muylem A, Knoop C, et al. Bronchiolitis obliterans syndrome in heart-lung transplant recipients: diagnosis with expiratory CT[J]. Radiology, 2001, 218(2): 533-539.
[17] Diab M, ZazaDitYafawi J, Soubani AO. Major pulmonary complications after hematopoietic stem cell transplant [J]. Exp Clin Transplant, 2016, 14(3): 259-270.
[18] Colom AJ, Teper AM. Post-infectious bronchiolitis obliterans [J]. Pediatr Pulmonol, 2019, 54(2): 212-219.
[19] 王丽宁, 胡炯. 异基因造血干细胞移植后闭塞性细支气管炎的诊断与治疗[J].内科理论与实践, 2018, 13(2): 118-123.
[20] Hostettler KE, Halter JP, Gerull S, et al. Calcineurin inhibitors in bronchiolitis obliterans syndrome following stem cell transplantation [J]. Eur Respir, 2014, 43(1): 221-232.
[21] 吴涛, 刘启发, 吴秀丽, 等. 以大环内酯类抗生素为主治疗异基因造血干细胞移植后阻塞性细支气管炎的疗效分析[J]. 中华血液学杂志, 2010(2): 114-115.
[22] Williams KM, Cheng GS, Pusic I, et al. Fluticasone, azithromycin, and montelukast treatment for new-onset bronchiolitis obliterans syndrome after hematopoietic cell transplantation[J]. Biol Blood Marrow Transplant, 2016, 22(4): 710-716.
[23] Sengsayadeth SM, Srivastava S, Jagasia M, et al. Time to explore preventive and novel therapies for bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation [J]. Biol Blood Marrow Transplant, 2012, 18(10): 1479-1487.
[24] Vogl UM, Nagayama K, Bojic M, et al. Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience [J]. Transplantation, 2013, 95(4): 623-628.
[25] Vieira AG, Funke VAM, Nunes EC, et al. Bronchiolitis obliterans in patients undergoing allogeneic hematopoietic SCT [J]. Bone Marrow Transpl, 2014, 49(6): 812-817.
[26] Carpenter PA, Kitko CL, Elad S, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report [J]. Biol Blood Marrow Transplant, 2015, 21(7): 1167-1187.
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