Chiba Tetsuhiro, Yokosuka Osamu, Kanda Tatsuo, Fukai Kenichi, Imazeki Fumio, Saisho Hiromitsu, Nishimura Miki, Saito Yasushi
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba-city, Chiba 260-8670, Japan.
Liver. 2002 Dec;22(6):514-7. doi: 10.1034/j.1600-0676.2002.01734.x.
Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone-marrow transplantation (BMT). The disease is often refractory to immunosuppressive therapy. We present a 30-year-old Japanese male, who developed an abrupt elevation of aminotransferases, on day 135 after allogeneic BMT. A liver biopsy specimen revealed degeneration of the small bile ducts and portal fibrosis, and the diagnosis of chronic hepatic GVHD was confirmed. No manifestation of chronic GVHD was observed except liver dysfunction. The administration of prednisolone (PSL) and cyclosporin (CsA) ameliorated laboratory data to a degree, but they did not return to normal. Treatment with ursodeoxycholic acid (UDCA), subsequently added to the immunosuppressive therapy, apparently normalized the levels of biliary tract enzyme and total bilirubin. His liver function test completely returned to normal on day 260. We believe that it is worthwhile to administer UDCA as an additional treatment for not only common hepatic GVHD but also atypical cases presenting as acute hepatitis.
肝移植物抗宿主病（GVHD）是骨髓移植（BMT）后常见的并发症。该疾病通常对免疫抑制治疗具有抗性。我们报告一名30岁的日本男性，在异基因BMT后第135天出现转氨酶突然升高。肝活检标本显示小胆管变性和门脉纤维化，慢性肝GVHD诊断得以证实。除肝功能障碍外，未观察到慢性GVHD的表现。泼尼松龙（PSL）和环孢素（CsA）治疗在一定程度上改善了实验室数据，但未恢复正常。随后在免疫抑制治疗中添加熊去氧胆酸（UDCA）进行治疗，明显使胆道酶和总胆红素水平恢复正常。他的肝功能检查在第260天完全恢复正常。我们认为，将UDCA作为附加治疗不仅用于常见的肝GVHD，也用于表现为急性肝炎的非典型病例是值得的。
