Karlas T, Weber J, Nehring C, Kronenberger R, Tenckhoff H, Mössner J, Niederwieser D, Tröltzsch M, Lange T, Keim V
1] Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany [2] Division of Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.
Division of Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany.
Bone Marrow Transplant. 2014 Jun;49(6):806-11. doi: 10.1038/bmt.2014.61. Epub 2014 Apr 7.
Hepatic complications contribute to morbidity and mortality after allogeneic hemopoietic SCT. Liver Doppler ultrasound and elastography represent promising methods for pretransplant risk assessment and early detection of complications. Ultrasound (liver and spleen size, liver perfusion) and elastography (transient elastography (TE); right liver lobe acoustic radiation force impulse imaging (r-ARFI); left liver lobe ARFI (l-ARFI)) were prospectively evaluated in patients with indications for allo-SCT. Measurements were performed before and repeatedly after SCT. Results were compared with the incidence of life-threatening complications and death during the first 150 days after SCT. Of 59 included patients, 16 suffered from major complications and 9 of them died within the follow-up period. At baseline, liver and spleen size, liver perfusion, TE and r-ARFI did not differ significantly between patients with and without severe complications. In contrast, l-ARFI was significantly elevated in patients who later developed severe complications (1.58±0.30 m/s vs 1.37±0.27 m/s, P=0.030). After SCT, l-ARFI values remained elevated and TE showed increasing liver stiffness in patients with complications. The value of conventional liver ultrasound for prediction of severe SCT complications is limited. Increased values for TE and l-ARFI are associated with severe SCT complications and demand further evaluation.
肝并发症会导致异基因造血干细胞移植后的发病率和死亡率。肝脏多普勒超声和弹性成像技术是用于移植前风险评估和并发症早期检测的有前景的方法。对有同种异体造血干细胞移植指征的患者前瞻性评估了超声检查（肝脏和脾脏大小、肝脏灌注）和弹性成像技术（瞬时弹性成像（TE）；右肝叶声学辐射力脉冲成像（r-ARFI）；左肝叶ARFI（l-ARFI））。在造血干细胞移植前和移植后多次进行测量。将结果与造血干细胞移植后前150天内危及生命的并发症发生率和死亡率进行比较。在纳入的59例患者中，16例发生了严重并发症，其中9例在随访期内死亡。基线时，有严重并发症和无严重并发症的患者在肝脏和脾脏大小、肝脏灌注、TE和r-ARFI方面无显著差异。相比之下，后来发生严重并发症的患者l-ARFI显著升高（1.58±0.30 m/s对1.37±0.27 m/s，P = 0.030）。造血干细胞移植后，有并发症患者的l-ARFI值持续升高，TE显示肝脏硬度增加。传统肝脏超声对预测严重造血干细胞移植并发症的价值有限。TE和l-ARFI值升高与严重造血干细胞移植并发症相关，需要进一步评估。
