Maeng Hoyoung, Lee Jae-Hyun, Cheong June Won, Lee Seung Tae, Hahn Jee Sook, Ko Yun Woong, Min Yoo Hong
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Int J Hematol. 2004 Jun;79(5):501-4. doi: 10.1532/ijh97.a10319.
Chronic graft-versus-host disease (GVHD) of the liver usually presents as an indolent cholestatic disease. We observed 3 patients in whom chronic GVHD of the liver after allogeneic nonmyeloablative hematopoietic stem cell transplantation (HSCT) presented with marked elevations of serum aminotransferases, clinically resembling acute viral hepatitis. The liver biopsies revealed predominant diffuse lobular injury and degenerative small bile ducts. Prompt administration of high-dose immunosuppressive therapy achieved a rapid improvement of liver enzymes and bilirubin levels. We conclude that a distinct syndrome of chronic hepatic GVHD presenting as an acute hepatitis should be considered as one possible explanation for hepatic dysfunction in patients who receive nonmyeloablative allogeneic HSCT.
慢性移植物抗宿主病（GVHD）的肝脏通常表现为一种进展缓慢的胆汁淤积性疾病。我们观察到3例患者，在接受非清髓性异基因造血干细胞移植（HSCT）后发生慢性肝脏GVHD，其血清转氨酶显著升高，临床上类似于急性病毒性肝炎。肝脏活检显示主要为弥漫性小叶损伤和退行性小胆管。及时给予大剂量免疫抑制治疗可使肝酶和胆红素水平迅速改善。我们得出结论，对于接受非清髓性异基因HSCT的患者，以急性肝炎形式出现的慢性肝脏GVHD这一独特综合征应被视为肝功能障碍的一种可能解释。
