Eltumi M, Trivedi P, Hobbs J R, Portmann B, Cheeseman P, Downie C, Risteli J, Risteli L, Mowat A P
Bone Marrow Transplant Unit, Westminster Children's Hospital, London, UK.
Lancet. 1993 Aug 28;342(8870):518-21. doi: 10.1016/0140-6736(93)91646-4.
Differential diagnosis of hepatic complications after bone marrow transplantation (BMT) is often difficult. To assess whether serum concentrations of the aminopropeptide of type III procollagen (PIIINP) could facilitate diagnosis, we measured serum PIIINP, corrected for age by conversion to standard deviation scores (SDS), serially after BMT in 27 children. A preliminary study of 11 patients showed that a PNIIINP-SDS cutoff of 8.0 was an optimum for diagnosis of veno-occlusive disease (VOD). PIIINP-SDS was increased above cut-off 1-25 days before the onset of clinical signs in the 12 patients (4 from the preliminary group, the others from a group of 16 studied prospectively) who developed VOD, with subsequent changes in PIIINP-SDS mirroring the course of VOD. By contrast, PIIINP-SDS remained below cut-off in all other patients, including 7 with liver graft-versus-host disease and 3 with drug hepatotoxicity. PIIINP-SDS values greater than 8.0 predict, diagnose, and monitor VOD after BMT.
骨髓移植（BMT）后肝脏并发症的鉴别诊断往往很困难。为了评估血清III型前胶原氨基端前肽（PIIINP）浓度是否有助于诊断，我们对27名儿童进行BMT后连续测量血清PIIINP，并通过转换为标准差评分（SDS）进行年龄校正。对11名患者的初步研究表明，PIIINP-SDS临界值为8.0是诊断肝静脉闭塞病（VOD）的最佳值。在发生VOD的12名患者（4名来自初步研究组，其他来自前瞻性研究的16名患者组）中，PIIINP-SDS在临床症状出现前1 - 25天升高至临界值以上，随后PIIINP-SDS的变化反映了VOD的病程。相比之下，在所有其他患者中，包括7名患有肝移植物抗宿主病和3名患有药物性肝毒性的患者，PIIINP-SDS均保持在临界值以下。BMT后PIIINP-SDS值大于8.0可预测、诊断和监测VOD。
