異基因造血干細胞移植術后毛細血管滲漏綜合征臨床特征及危險因素分析_《華西醫學》

作者：

陳心傳 ,  劉霆 , 賈永前 , 劉志剛 , 代陽 , 李建軍

四川大學華西醫院血液內科（成都，610041）;

關鍵詞：

異基因造血干細胞移植毛細血管滲漏綜合征羥乙基淀粉

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【摘要】　目的　分析異基因造血干細胞移植術（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并發毛細血管滲漏綜合征（capillary leak syndrome，CLS）的發生率、危險因素和結局，并探討其防治措施。　方法　回顧性分析2005年6月-2011年2月住院的allo-HSCT術后14例并發CLS的臨床資料。　結果　 CLS發生率為9.2%（14/152）。年齡、性別、診斷、HLA配型、預處理、CD34+細胞量、粒細胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入時間均不能認定為造血干細胞移植后CLS誘發因素。　結論　 HSCT術后CLS誘因尚不清楚，采用限水、減量G-CSF、使用糖皮質激素和羥乙基淀粉等措施及時治療，有助于控制CLS。
【Abstract】　Objective　 To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment.　Methods　 We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011.　Results　 Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS.　Conclusions　 Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.

引用本文： 陳心傳,劉霆,賈永前,劉志剛,代陽,李建軍. 異基因造血干細胞移植術后毛細血管滲漏綜合征臨床特征及危險因素分析. 華西醫學, 2011, 26(12): 1774-1779. doi: 復制

1.	Tian J, Lin X, Guan R, et al. The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J]. Anesth Analg, 2004, 98(3): 768-774.
2.	Cahill RA, Spitzer TR, Mazumder A. Marrow engraftment and clinical manifestations of capillary leak syndrome[J]. Bone Marrow Transplant, 1996, 18(1): 177-184.
3.	Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading[J]. Bone Marrow Transplant, 1995, 15(6): 825-828.
4.	Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26(9): 1252-1258.
5.	Marx G. Fluid therapy in sepsis with capillary leakage[J]. Eur J Anaesthesiol, 2003, 20(6): 429-442.
6.	Lee CK, Gingrich RD, Hohl RJ, et al. Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation[J]. Bone Marrow Transplant, 1995, 16(1): 175-182.
7.	Guan H, Nagarkatti PS, Nagarkatti M. Blockade of hyaluronan inhibits IL-2-induced vascular leak syndrome and maintains effectiveness of IL-2 treatment for metastatic melanoma[J]. J Immunol, 2007, 179(6): 3715-3723.
8.	de Azevedo AM, Goldberg Tabak D. Life-threatening capillary leak syndrome after G-CSF mobilization and collection of peripheral blood progenitor cells for allogeneic transplantation[J]. Bone Marrow Transplant, 2001, 28(3): 311-312.
9.	Stief TW. Capillary leak syndrome caused by cytostatics[J]. Ann Hematol, 2005, 84(7): 484.
10.	Takatsuka H, Takemoto Y, Yamada S, et al. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome[J]. Bone Marrow Transplant, 2000, 26(4): 419-426.
11.	李智泉, 王晨虹. 羥乙基淀粉和白蛋白擴容治療對重度子癇前期并發毛細血管滲漏綜合征肺功能的影響[J]. 臨床急診雜志, 2010, 11(5): 281-283.
12.	Lv R, Zhou W, Chu C, et al. Mechanism of the effect of hydroxyethyl starch on reducing pulmonary capillary permeability in a rat model of sepsis[J]. Ann Clin Lab Sci, 2005, 35(2): 174-183.
13.	Boldt J. Do plasma substitutes have additional properties beyond correcting volume deficits? [J]. Shock, 2006, 25(2): 103-116.
14.	Feng X, Yan W, Wang Z, et al. Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage[J]. Anesth Analg, 2007, 104(3): 624-630.
15.	Vincent JL. Plugging the leaks? New insights into synthetic colloids[J]. Crit Care Med, 1991, 19(3): 316-318.
16.	Hoffmann JN, Vollmar B, Laschke MW, et al. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia[J]. Anesthesiology, 2002, 97(2): 460-470.
17.	Atkinson JP, Waldmann TA, Stein SF, et al. Systemic capillary leak syndrome and monoclonal IgG gammopathy, studies in a sixth patient and a review of the literature[J]. Medicine (Baltimore), 1977, 56(3): 225-239.
18.	Chihara R, Nakamoto H, Arima H, et al. Systemic capillary leak syndrome[J]. Intern Med, 2002, 41(11): 953-956.

1. 　Tian J, Lin X, Guan R, et al. The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J]. Anesth Analg, 2004, 98(3): 768-774.
2. 　Cahill RA, Spitzer TR, Mazumder A. Marrow engraftment and clinical manifestations of capillary leak syndrome[J]. Bone Marrow Transplant, 1996, 18(1): 177-184.
3. 　Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading[J]. Bone Marrow Transplant, 1995, 15(6): 825-828.
4. 　Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26(9): 1252-1258.
5. 　Marx G. Fluid therapy in sepsis with capillary leakage[J]. Eur J Anaesthesiol, 2003, 20(6): 429-442.
6. 　Lee CK, Gingrich RD, Hohl RJ, et al. Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation[J]. Bone Marrow Transplant, 1995, 16(1): 175-182.
7. 　Guan H, Nagarkatti PS, Nagarkatti M. Blockade of hyaluronan inhibits IL-2-induced vascular leak syndrome and maintains effectiveness of IL-2 treatment for metastatic melanoma[J]. J Immunol, 2007, 179(6): 3715-3723.
8. 　de Azevedo AM, Goldberg Tabak D. Life-threatening capillary leak syndrome after G-CSF mobilization and collection of peripheral blood progenitor cells for allogeneic transplantation[J]. Bone Marrow Transplant, 2001, 28(3): 311-312.
9. 　Stief TW. Capillary leak syndrome caused by cytostatics[J]. Ann Hematol, 2005, 84(7): 484.
10. 　Takatsuka H, Takemoto Y, Yamada S, et al. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome[J]. Bone Marrow Transplant, 2000, 26(4): 419-426.
11. 　李智泉, 王晨虹. 羥乙基淀粉和白蛋白擴容治療對重度子癇前期并發毛細血管滲漏綜合征肺功能的影響[J]. 臨床急診雜志, 2010, 11(5): 281-283.
12. 　Lv R, Zhou W, Chu C, et al. Mechanism of the effect of hydroxyethyl starch on reducing pulmonary capillary permeability in a rat model of sepsis[J]. Ann Clin Lab Sci, 2005, 35(2): 174-183.
13. 　Boldt J. Do plasma substitutes have additional properties beyond correcting volume deficits? [J]. Shock, 2006, 25(2): 103-116.
14. 　Feng X, Yan W, Wang Z, et al. Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage[J]. Anesth Analg, 2007, 104(3): 624-630.
15. 　Vincent JL. Plugging the leaks? New insights into synthetic colloids[J]. Crit Care Med, 1991, 19(3): 316-318.
16. 　Hoffmann JN, Vollmar B, Laschke MW, et al. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia[J]. Anesthesiology, 2002, 97(2): 460-470.
17. 　Atkinson JP, Waldmann TA, Stein SF, et al. Systemic capillary leak syndrome and monoclonal IgG gammopathy, studies in a sixth patient and a review of the literature[J]. Medicine (Baltimore), 1977, 56(3): 225-239.
18. 　Chihara R, Nakamoto H, Arima H, et al. Systemic capillary leak syndrome[J]. Intern Med, 2002, 41(11): 953-956.

《華西醫學》

異基因造血干細胞移植術后毛細血管滲漏綜合征臨床特征及危險因素分析

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《華西醫學》

異基因造血干細胞移植術后毛細血管滲漏綜合征臨床特征及危險因素分析

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