异基因造血干细胞移植术后患者免疫状态评估与治疗调整

摘要

Graft-versus-host disease ( GVHD ) is a common complication following allogeneic hematopoietic stem cell transplantation( Allo-HSCT) , which is characterized by autoimmune like inflammatory responses. But its symp-toms are similar to the symptoms of infection caused by excessive immune suppression, and the treatment is oppo-site. Therefore, the immune status of patients after Allo-HSCT should be closely monitored to guide the clinical medication. We selected a patient after Allo-HSCT. The patient presented obvious GVHD symptoms like abdominal pain, diarrhea and skin rash after transplanting, and was diagnosed with severe GVHD at first,treated with immu-nosuppressive therapy. But these symptoms not only were not improved, but also were followed with severe pulmo-nary fungal infection. Later we found that the proportion of regulatory T cells( Treg) was significantly increased in the patient. So we reduced the dose of immune suppression drugs and finally stopped, and then the patient after Al-lo-HSCT symptoms was relieved, Treg level returned to normal. In general, while the patient had appears symp-toms like GVHD, the dose of immune suppression drugs should not be increased blindly. The clinical manifestation and laboratory examination, especially Treg level of the patients should be analyzed to estimate the presence of ex-cessive immune suppression, then adjust the treatment based on the results.%选取1例异基因造血干细胞移植术(Allo-HSCT)后患者,该患者移植后出现反复腹痛、腹泻及皮疹等症状,起初考虑为重度移植物抗宿主病(GVHD),并给予强免疫抑制治疗.后患者症状一直无明显改善,且出现严重肺部真菌感染.后来检查发现该患者调节性T细胞(Treg细胞)比例明显升高,故针对性的对免疫抑制药物进行减量直至停用,最终患者症状缓解,Treg细胞恢复至基本正常水平.因此,对于Allo-HSCT后患者出现类GVHD症状时不能盲目加量应用免疫抑制剂,而应综合患者临床表现、实验室检查,尤其是Treg细胞情况判断患者是否存在过度免疫抑制可能,并根据结果调整治疗方案.