Research progress on posttransplant lymphoproliferative disease after lung transplantation
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摘要: 移植后淋巴组织增生性疾病(PTLD)是肺移植术后可致死性并发症,与年龄、免疫抑制水平、爱泼斯坦-巴尔病毒(EBV)感染等密切相关。降低免疫抑制水平、利妥昔单抗治疗、T细胞免疫治疗是其常见的治疗手段。随着肺移植在中国的迅速发展,肺移植术后PTLD也引起高度关注。本文就肺移植术后发生PTLD的危险因素、病理分型、临床表现、诊断、治疗、预后和预防做一综述,旨在为肺移植术后PTLD发生、发展的早期监测和管理提供参考。
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关键词:
- 肺移植 /
- 慢性移植肺功能障碍(CLAD) /
- 移植后淋巴组织增生性疾病(PTLD) /
- 爱泼斯坦-巴尔病毒(EBV) /
- 免疫抑制 /
- 利妥昔单抗 /
- 移植物抗宿主病(GVHD) /
- 闭塞性细支气管炎综合征
Abstract: Posttransplant lymphoproliferative disease (PTLD) is a fatal complication after lung transplantation, which is intimately associated with age, immunosuppression level and Epstein-Barr virus (EBV) infection, etc. Reducing immunosuppression level, rituximab therapy and T cell immunotherapy are common treatments for PTLD. With the rapid development of lung transplantation in China, PTLD after lung transplantation has attracted widespread attention. This article reviews the risk factors, pathological types, clinical manifestations, diagnosis, treatment, prognosis and prevention of PTLD after lung transplantation, aiming to provide reference for early monitoring and management of the incidence and progression of PTLD. -
表 1 2016年WHO的PTLD组织学分类[21]
Table 1. WHO histological classification of PTLD in 2016
类型 组织学分类 早期病变 浆细胞增生性PTLD 传染性单核细胞增多性PTLD 旺炽性滤泡增生性PTLD 多形性PTLD 单形性PTLD (依据类似的淋巴瘤分类) B细胞淋巴瘤 弥漫性大B细胞淋巴瘤 Burkitt淋巴瘤 浆细胞骨髓瘤 其他 T细胞淋巴瘤 外周T细胞淋巴瘤,非特指型 肝脾T细胞淋巴瘤 其他 经典霍奇金淋巴瘤型PTLD -
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