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时间:2019-02-04
《自体外周血干细胞移植治疗难治性天疱疮一例》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、维普资讯http://www.cqvip.com志2007年1月第4o卷笫麴hi.衄型!::13·论著·自体外周血干细胞移植治疗难治性天疱疮一例曾抗孙竞孙乐栋盂凡义刁友涛徐丹黄良赵洁刘启发【摘要】目的探讨自体外周血干细胞移植治疗天疱疮的可能性。病历资料男性患者,35岁,全身反复大疱4年余,根据Il缶床表现、组织病理和免疫荧光检查确诊为天疱疮。经糖皮质激素和免疫抑制剂治疗效果不佳,2月前出现髋关节疼痛,经x线和CT检查诊断为股骨头无菌性坏死。采取环磷酰胺及粒细胞集落刺激因子作为动员剂,利妥昔单抗联合净化。用环磷酰胺联合抗胸腺细胞球蛋白、利
2、妥昔单抗进行预处理,同时碱化和水化尿液,保护心、肝和肾功能。观察移植后Il缶床表现、造血和免疫指标等的变化。结果患者移植结束即停用糖皮质激素。3周后自觉双侧髋关节疼痛减轻,复查CT示股骨头缺血性改变减轻。移植6周后直接免疫荧光和间接免疫荧光检查转阴并持续阴性。经一年复诊,Il缶床及免疫学检查均无复发迹象。结论本研究结果提示自体外周血干细胞移植治疗天疱疮近期疗效显著.可能是治疗存在治疗抵抗的重症天疱疮潜在的“根治”方法.但其风险收益比尚需进一步评价。【关键词】天疱疮;造血干细胞;移植,自体;利妥昔单抗Autologousperiphera
3、lhematopoieticstemcelltransplantationinapatientwithrefractorypemphi-gusZENGKang',SUNJing,SUNLe-dong,慢NGFan-~,DIAOYou-tao,XUDan,HUANGLiang,ZHADYie,LIUQi-fa."DepartmentofDermatology,NanfangHospi~,SouthernMedicalUniversity,Guangzhou510515,China【Abstract】ObjectiveToexploreth
4、epossibilityofautologousperipheralhematopoieticstemcelltransplantationintreatmentwithrefractorypemphigus.PatientandInterventionA35-year-oldmalepa.tientpresentedwitha4-yearhistoryofrecurrentbullaeonhistrunkandextremities.Thediagnosisofpem.phiguswasIl1adeonthebasisofthecli
5、nical,histologic,andimmunofluorescencefindings.Thepatientshowedresistancetoconventionaltherapywithglucocorticoidandimmunosuppressiveagents.TwOmonthsbeforeadmission,hecomplainedofhipjointpain,andX.rayandCTSCanrevealedamicrobicnecrosisofthe~moralhead.Stem-eellmobilizationw
6、asachievedbytreatmentwithcyclophosphamide.granulocytecolony-stimulatingfactor(G—CSF).andrituximab.Peripheralbloodstemcellswerecollectedvialeuka-pheresisandcryopreservedforlateruse.Immunoablationwasaccomplishedusingcyclophosphamidef200mg/kg;divided50mkgondays-5,-4,-3,and-
7、2),antithymocyteglobulin(ATG;10mg/kg;divided2.5mg/kgondays-6,-5,-4,and一3),andrituximab(1200mg/d;divided600mg/dondays0and7).Autolo-gousperipheralhematopoieticstemcelltransplantationWaSfollowedbyreconstitutionof血eimmunesys.tern,whichWaSmonitoredbyflowc~ometry.ResultsTheglu
8、cocorticoidwaswithdrawnimmediatelyaf-tertransplantation.Hispemphigustiterturnednegativeat6weekspost-tra
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