造血干细胞移植后非感染性肺部并发症的诊治进展

摘要/Abstract

中图分类号:

R715.2

许晓倩, 卿恺, 张苏江. 造血干细胞移植后非感染性肺部并发症的诊治进展[J]. 诊断学理论与实践, 2021, 20(06): 515-521.

图/表4

表1

肺实质	血管内皮	气道上皮
急性呼吸窘迫综合征	移植期呼吸窘迫综合征	隐源性机化性肺炎
迟发性肺毒性综合征	弥漫性肺泡出血	闭塞性细支气管炎
急性间质性肺炎

表2

表3

表4

常见非感染性肺部并发症的临床特点

分类	好发时间	危险因素	检查	影像学	临床表现	治疗
PERDS	植入期,多在移植后2周	女性、GM-CSF	HRCT	弥漫性磨玻璃样阴影,胸腔积液	低氧血症伴发热、皮疹	糖皮质激素,预后好
DAH	移植后11~21 d	药物、感染、GVHD	支气管肺泡灌洗	早期磨玻璃样阴影和实变伴空气支气管征, 后期铺路石改变	低氧血症、咯血、咳白痰	针对病因治疗,通气支持及激素,预后差
COP	移植后2~15个月, 中位108 d	女供男、HLA 配型不合、急慢性 GVHD	HRCT及肺功能	肺有实变或斑片影,可伴有磨玻璃样和结节样改变	发热、干咳和呼吸困难	糖皮质激素
BOS	移植后第3个月至2年	移植前低FEV₁/FVC、急或慢性GVHD、无关或女性供体、	HRCT及肺功能	马赛克征、气体闭陷征、外周支气管管壁增厚和扩张	气流阻塞的相关症状	免疫抑制剂,FAM 方案
PPFE	移植后数月至数年	预处理放化疗及 GVHD	HRCT及肺功能	上叶纤维化伴胸膜下及胸膜下增厚伴缩窄、体积缩小及牵引性支气管扩张	干咳、呼吸困难	肺移植
TALS	继发于BOS、COP 及ILD	慢性GVHD、男性、移植时年龄<38岁和使用他克莫司	胸片、CT	气胸	胸痛、呼吸困难	胸腔闭式引流
肺动脉高压	移植后2~6个月	放化疗损伤	超声心动图、右心导管术	右心室增大,肺弥漫性磨玻璃样改变	右心衰症状	类前列腺素、内皮素受体拮抗剂等
PTLD	移植后前6个月	去T细胞移植物、抗胸腺细胞球蛋白使用、 GVHD等	血EB拷贝数、 PET/CT及活检	PET/CT检查出现高代谢病灶	发热、淋巴结肿大及呼吸系统症状	免疫抑制剂减停及利妥昔单抗

表4

参考文献31

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造血干细胞移植后非感染性肺部并发症的诊治进展

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