• 四川大學(xué)華西醫(yī)院血液內(nèi)科（成都，610041）;

【摘要】　目的　 分析異基因造血干細(xì)胞移植術(shù)（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并發(fā)毛細(xì)血管滲漏綜合征（capillary leak syndrome，CLS）的發(fā)生率、危險(xiǎn)因素和結(jié)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(shù)后14例并發(fā)CLS的臨床資料。　結(jié)果　 CLS發(fā)生率為9.2%（14/152）。年齡、性別、診斷、HLA配型、預(yù)處理、CD34+細(xì)胞量、粒細(xì)胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入時(shí)間均不能認(rèn)定為造血干細(xì)胞移植后CLS誘發(fā)因素。　結(jié)論　 HSCT術(shù)后CLS誘因尚不清楚，采用限水、減量G-CSF、使用糖皮質(zhì)激素和羥乙基淀粉等措施及時(shí)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(yáng),李建軍. 異基因造血干細(xì)胞移植術(shù)后毛細(xì)血管滲漏綜合征臨床特征及危險(xiǎn)因素分析. 華西醫(yī)學(xué), 2011, 26(12): 1774-1779. doi: 復(fù)制

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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(kuò)容治療對(duì)重度子癇前期并發(fā)毛細(xì)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. 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. 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. 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. 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. 5. 　Marx G. Fluid therapy in sepsis with capillary leakage[J]. Eur J Anaesthesiol, 2003, 20(6): 429-442.
  6. 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. 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. 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. 9. 　Stief TW. Capillary leak syndrome caused by cytostatics[J]. Ann Hematol, 2005, 84(7): 484.
  10. 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. 11. 　李智泉, 王晨虹. 羥乙基淀粉和白蛋白擴(kuò)容治療對(duì)重度子癇前期并發(fā)毛細(xì)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. 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. 13. 　Boldt J. Do plasma substitutes have additional properties beyond correcting volume deficits? [J]. Shock, 2006, 25(2): 103-116.
  14. 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. 15. 　Vincent JL. Plugging the leaks? New insights into synthetic colloids[J]. Crit Care Med, 1991, 19(3): 316-318.
  16. 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. 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. 18. 　Chihara R, Nakamoto H, Arima H, et al. Systemic capillary leak syndrome[J]. Intern Med, 2002, 41(11): 953-956.