Chai J J, Liu T, Cai B Q, Zhu H D
Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Jul 12;40(7):504-508. doi: 10.3760/cma.j.issn.1001-0939.2017.07.005.
To analyze the clinical features of bronchiolitis obliterans syndrome (BOS) in patients with allogeneic hematopoietic stem cell transplantation (HSCT). This retrospective study included patients who underwent allogeneic HSCT from January 1998 to December 2016. The clinical features, radiological manifestations and treatment of clinically proven BOS were reviewed. Of 681 patients who experienced HSCT, 10(1.47%) met the diagnostic criteria. The duration of BOS onset after transplantation was 5-48 months, averaging (18±15) months. Cough and worsening dyspnea were present in most cases, and 9 (90%) of the cases had manifestations of chronic graft versus host disease. Hyperinflation with areas of decreased attenuation and bronchiectasis were present in 7 (70%) cases and air trapping was present during the expiratory phase of imaging. The management of BOS consisted of high dose systemic corticosteroids and immunosuppressive therapy. Patients were treated with bronchodilators if they were symptomatic and during acute exacerbations of respiratory symptoms. In 5 (50%) patients the condition deteriorated and caused death, while in 3 patients the condition was improved. Two patients were lost to follow up. BOS is the most common late noninfectious pulmonary complication following allogeneic HSCT and has a poor prognosis.
分析异基因造血干细胞移植(HSCT)患者闭塞性细支气管炎综合征(BOS)的临床特征。这项回顾性研究纳入了1998年1月至2016年12月期间接受异基因HSCT的患者。对临床确诊的BOS的临床特征、影像学表现及治疗情况进行了回顾。在681例接受HSCT的患者中,10例(1.47%)符合诊断标准。移植后BOS发病时间为5 - 48个月,平均(18±15)个月。多数病例有咳嗽和进行性加重的呼吸困难,9例(90%)有慢性移植物抗宿主病表现。7例(70%)病例存在肺过度充气伴密度减低区及支气管扩张,影像学呼气期可见空气潴留。BOS的治疗包括大剂量全身用糖皮质激素和免疫抑制治疗。有症状的患者及呼吸道症状急性加重时给予支气管扩张剂治疗。5例(50%)患者病情恶化并导致死亡,3例病情好转。2例失访。BOS是异基因HSCT后最常见的晚期非感染性肺部并发症,预后较差。