Tomás J F, Pinilla I, García-Buey M L, García A, Figuera A, Moreno R, Fernández-Rañada J M
Department of Hematology, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Spain.
Bone Marrow Transplant. 2000 Sep;26(6):649-55. doi: 10.1038/sj.bmt.1702532.
This retrospective study has aimed at determining the prevalence, aetiology and clinical evolution of chronic liver disease (CLD) after allogeneic bone marrow transplantation (BMT). A total of 106 patients who had been transplanted in a single institution and who had survived for at least 2 years after BMT were studied. The prevalence of CLD was 57.5% (61/106). In 47.3% of cases more than one aetiopathogenic agent coexisted. The causes of CLD were iron overload (52.4%), chronic hepatitis C (47.5%), chronic graft-versus-host disease (C-GVHD) (37.7%), hepatitis B (6.5%), non-alcoholic steatohepatitis (NASH) (4.9%), autoimmune hepatitis (AIH) (4.9%) and unknown two (3.3%). Twenty-three patients with iron overload underwent venesections which were well tolerated. An improvement in liver function tests (LFTs) was observed in 21 (91%) patients. All six patients with siderosis as the only cause of CLD normalized LFT as well as three patients with HCV infection. Clinical evolution was satisfactory for patients with GVHD, AIH, NASH and hepatitis B. At the last visit 23 patients continued with abnormal LFTs, and 19 of them were infected by the HCV. A sustained biochemical and virologic response was achieved in only one case out of six patients with CHC who received interferon. We have found that CLD is a common complication in long-term BMT survivors. The aetiology is often multifactorial, iron overload, CHC and C-GVHD being the main causes. The CLD followed a rather 'benign' and slow course in our patients as none of them developed symptoms or signs of liver failure and we did not observe an increase in morbidity or mortality in these patients, but a longer follow-up is necessary in HCV infected patients based on the natural history of this infection in other populations.
这项回顾性研究旨在确定异基因骨髓移植（BMT）后慢性肝病（CLD）的患病率、病因及临床演变情况。对在单一机构接受移植且BMT后存活至少2年的106例患者进行了研究。CLD的患病率为57.5%（61/106）。47.3%的病例存在一种以上致病因素。CLD的病因包括铁过载（52.4%）、慢性丙型肝炎（47.5%）、慢性移植物抗宿主病（C-GVHD）（37.7%）、乙型肝炎（6.5%）、非酒精性脂肪性肝炎（NASH）（4.9%）、自身免疫性肝炎（AIH）（4.9%）以及不明原因（3.3%）。23例铁过载患者接受了静脉放血治疗，耐受性良好。21例（91%）患者的肝功能检查（LFTs）有所改善。6例以铁沉着症为CLD唯一病因的患者以及3例丙型肝炎病毒（HCV）感染患者的LFTs均恢复正常。对于移植物抗宿主病、自身免疫性肝炎、非酒精性脂肪性肝炎和乙型肝炎患者，临床演变情况令人满意。在最后一次随访时，23例患者的LFTs仍异常，其中19例感染了HCV。6例接受干扰素治疗的慢性丙型肝炎患者中仅1例实现了持续的生化和病毒学应答。我们发现，CLD是长期BMT存活者的常见并发症。病因通常是多因素的，铁过载、慢性丙型肝炎和慢性移植物抗宿主病是主要原因。在我们的患者中，CLD病程较为“良性”且进展缓慢，因为他们均未出现肝功能衰竭的症状或体征，且我们未观察到这些患者的发病率或死亡率增加，但基于其他人群中这种感染的自然病史，对HCV感染患者需要进行更长时间的随访。
