Chen P M, Fan S, Hsieh R K, Liu R S, Tzeng C H, Chiou T J, Liu J H
Department of Internal Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.
Bone Marrow Transplant. 1992 Jun;9(6):415-9.
Twenty-two patients with previous hepatic compromise who underwent allogeneic bone marrow transplant (BMT) for treatment of hematologic malignancy or other hematologic disease between 1984 and 1990 were chosen for the present study. After transplant, 19 (86.4%) of the patients developed hepatitis, including six cases (27.3%) of acute hepatitis, 12 (54.6%) of chronic hepatitis and one uncharacterized hepatitis. Nine chronic hepatitis patients were followed-up for 7-56.5 months (medium 35.5 months) with biochemistry studies and ultrasonography. Throughout the observation period, liver cirrhosis or hepatoma were not detected and no patients developed veno-occlusive disease. Furthermore patients who developed hepatitis after transplant had worse prognoses. Based on serial serological survey of the various hepatitis B virus (HBV) antigens and antibodies, we have found that most of the recurrent viral hepatitis in transplant patients could be attributed to the reactivation of the virus. In addition, the use of immunosuppressive drugs, persisting infection by HCV and the development of graft-versus-host disease may also play a role in modulating the course of viral hepatitis in BMT patients.
本研究选取了1984年至1990年间因血液系统恶性肿瘤或其他血液系统疾病接受异基因骨髓移植（BMT）的22例既往有肝脏损害的患者。移植后，19例（86.4%）患者发生肝炎，其中急性肝炎6例（27.3%），慢性肝炎12例（54.6%），1例肝炎性质不明。对9例慢性肝炎患者进行了7至56.5个月（平均35.5个月）的随访，包括生化检查和超声检查。在整个观察期内，未检测到肝硬化或肝癌，也没有患者发生肝静脉闭塞病。此外，移植后发生肝炎的患者预后较差。通过对各种乙肝病毒（HBV）抗原和抗体的系列血清学调查，我们发现移植患者中大多数复发性病毒性肝炎可归因于病毒的重新激活。此外，免疫抑制药物的使用、丙型肝炎病毒的持续感染以及移植物抗宿主病的发生也可能在调节BMT患者病毒性肝炎的病程中发挥作用。
