LUNG-DISEASES AFTER BONE-MARROW TRANSPLANTATION - RESULTS OF A CLINICAL, RADIOLOGICAL, HISTOLOGICAL, IMMUNOLOGICAL AND LUNG-FUNCTION STUDY
LUNG-DISEASES AFTER BONE-MARROW TRANSPLANTATION - RESULTS OF A CLINICAL, RADIOLOGICAL, HISTOLOGICAL, IMMUNOLOGICAL AND LUNG-FUNCTION STUDY
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DOI：
10.1007/bf01735262
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发表时间：
1986-07-01
期刊：
影响因子：
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通讯作者：
OSTENDORF, P
中科院分区：
文献类型：
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作者：
LINK, H;REINHARD, U;OSTENDORF, P
本文分析了72例骨髓移植（BMT）后继发肺部疾病的病例，其中急性白血病44例，慢性粒细胞白血病10例，重型再生障碍性贫血16例，神经母细胞瘤2例。38名患者共发生51例肺部并发症，其中20例导致死亡。13例患者中，3例死于细菌性肺炎，均发生在粒细胞减少症期间; 6例患者中有2例死于真菌性肺炎，3例患者中有2例死于细菌-支原体混合感染。成人呼吸窘迫综合征（ARDS）死亡2例。低于500/μ l的粒细胞计数与细菌性、真菌性和ARDS肺炎以及支气管炎的致命结果显著相关（P < 0.002）。病毒性肺炎导致9例患者中的8例死亡;在每例患者中，与移植物抗宿主病（GvHD）有显著相关性（P < 0.05）。肺部疾病反复发作的患者有明显更多的慢性GvHD（P < 0.05）;其中一些患者显示外周血辅助性T细胞减少。自然杀伤（NK）细胞减少，激活的NK细胞水平的百分比介于6%和69%之间。B细胞缺乏或缺乏。这些发现部分解释了特异性抗体反应性的缺乏。这些患者中有5例还感染了GvHD相关的阻塞性细支气管炎，对治疗无反应。8例患者（11.1%）发生不明原因的肺浸润（包括特发性间质性肺炎），3例患者发生致死性结局。骨髓移植后肺功能有显著性变化（P < 0.05），表现为肺活量（VC）降低，残气量（RV）增加，残气量占肺总容量的百分比增加。肺部疾病是骨髓移植后最常见的并发症和死亡原因。
The case histories of 72 subsequently treated patients .sbd.44 with acute leukemia, 10 with chronic myeloid leukemia, 16 with severe aplastic anemia and 2 with neuroblastoma .sbd.were analyzed after bone marrow transplantation (BMT) with respect to pulmonary diseases. Thirty-eight patients suffered from a total of 51 pulmonary complications, which led to death in 20. Of 13 patients, 3 died of bacterial pneumonia, all of them during granulocytopenia; 2 of 6 patients died of fungal pneumonia and 2 out of 3 of a mixed bacterial-mycotic infection. Adult respiratory distress syndrome (ARDS) led to death in 2 patients. A granulocyte count under 500/.mu.l correlated significantly (P < 0.002) with the fatal outcome of bacterial, fungal and ARDS pneumonia as well as with bronchitis. Viral pneumonia led to death in 8 of 9 patients; in each there was a significant correlation (P < 0.05) with graft-versus-host disease (GvHD). Patients with repeated episodes of pulmonary illness had significantly more chronic GvHD (P < 0.05); several of these patients displayed a reduction in helper T cells in the peripheral blood. The natural killer (NK) cells were reduced and the percentage of activated NK cell level lay between 6% and 69%. B-cells were absent or deficient. These findings explain in part the absence of specific antibody reactivity. Five of these patients also contracted GvHD-associated obstructive bronchiolitis, which did not respond to therapy. Pulmonary infiltrates of unknown origin (including idiopathic interstitial pneumonia) occurred in 8 of the patients (11.1%), with a fatal outcome in 3 patients. Significant changes (P < 0.05) in lung function after BMT appeared in the form of reduced vital capacity (VC) increased residual volume (RV) and an increase in RV expressed as the percentage of total lung capacity. Pulmonary diseases were the most common complication and cause of death in our patients after BMT.