异基因造血干细胞移植后肝静脉闭塞病及超声表现

摘要

Objective To explore the clinical and sonographic manifestation of hepatic veno-occlusive disease (HVOD) after allogeneic haemopoietic stem cell transplantation (allo-HSCT). Methods In the pre and post allo-HSCT,the abdomen ultrasound was performed for each patient. The changes of sonographic manifestation of abdomen organs were observed. The clinical and sonographic data of HVOD patients underwent allo-HSCT were retrospectively analyzed.Results There were 7 patients with HVOD after allo-HSCT (7/137,5. 1％). The times of happened was 7 to 23 days.The serum bilirubin was 65 to 271 umol/L. The clinical manifestation included right hypochondrial region(5/7,71.4％),hepatomegaly (6/7,85.7 ％), weight gain ( 7/7,100 ％ ), and ascites ( 7/7,100 ％ ). Contrast to pre-transplantation, the sonographic manifestation of patients with HVOD were significantly differenced by hepatomegaly, hepatic vein tenuous,spleen volume augmentation, and ascites (P＜0.05). On the other hand, the sonographic manifestation of patients with HVOD were unsignificantly differenced by hepatic parenchyma impairment and gallbladder wall thickening (P＞0. 05).Conclusion The patients who have weight gain and ascites without definite reason should be considered HVOD after alloHSCT. The bedsides abdominal ultrasound examination is essential for diagnoses and treatments of HVOD patients.%目的 探讨异基因造血干细胞移植(allo-HSCT)后肝静脉闭塞病(HVOD)的临床及超声表现.方法 时allo-HSCT前后的患者进行腹部超声检查,观察腹腔脏器的超声图像改变,并将发生HVOD患者的临床和超声资料进行回顾性分析.结果 移植后进行超声检查的患者共137例,发生HVOD患者7例,发生率5.1%,发生时间7～23天,血清胆红素65～271/μmol/L,部分患者出现右上腹痛(517/71.4%),肝大(6/7,85.7%),体重增加(7/7,100%),腹水(7/7,100%).同移植前比较,患者在移植后发生肝大、肝静脉纤细、脾体积增大及腹水等变化,差异有显著性意义(P<0.05);而肝实质损害、胆囊壁增厚等变化,其差异无显著性意义(P>0.05).结论 异基因造血干细胞移植患者,在移植后出现不明原因的体重增加和腹水,应警惕HVOD的可能,床旁腹部超声检查能为其临床提供有价值的诊断信息.