儿童异基因造血干细胞移植后闭塞性细支气管炎综合征研究进展
收稿日期: 2022-08-22
网络出版日期: 2023-08-10
基金资助
国家自然科学基金项目(81874187);国家自然科学基金项目(81472706)
Research advances of the bronchiolitis obliterans syndrome following allogeneic hematopoietic stem cell transplant in children
Received date: 2022-08-22
Online published: 2023-08-10
闭塞性细支气管炎综合征（BOS）是儿童异基因造血干细胞移植后罕见且致命的非感染性肺部并发症之一。原发性移植物功能不良、移植物抗宿主病、淋巴细胞浸润性细支气管炎、胃食管反流、空气污染等多种危险因素与儿童造血干细胞移植后BOS的发生密切相关。由于早期症状不明显、开放性肺活检风险高、病理生理改变不可逆及部分患儿激素治疗效果不理想等原因，儿童移植后BOS的临床诊疗十分具有挑战性。文章综述儿童异基因造血干细胞移植后BOS的流行病学特点、发病机制、诊断方法及治疗进展，为进一步完善适用于儿童移植后BOS的诊疗规范提供建议。
关键词： 闭塞性细支气管炎综合征; 造血干细胞移植; 儿童
习必鑫 , 胡群 综述 , 刘爱国 审校 . 儿童异基因造血干细胞移植后闭塞性细支气管炎综合征研究进展[J]. 临床儿科杂志, 2023 , 41(8) : 629 -633 . DOI: 10.12372/jcp.2023.22e1137
Bronchiolitis obliterans syndrome (BOS) is one of the rare and fatal non-infectious pulmonary complications after allogeneic haematopoietic stem cell transplantation (HSCT) in children. Mutiple risk factors such as primary graft dysfunction, graft-versus-host disease (GVHD), lymphocytic bronchiolitis, gastro-oesophageal reflux, and air pollution, particularly in children, have been reported to be the most common contributions to the bronchiolitis obliterans syndromepost-HSCT. An early diagnosis and treatment of BOS following HSCT is challenging due to the lack of obvious early symptoms, high risk of open lung biopsy, irreversible pathophysiological changes, and the failure of steroid treatment in some children. In this review, we summarize research advances in the epidemiology, pathogenesis, diagnosis, and treatment of this lethal noninfectious pulmonary complication, and provide suggestions for further improvement of diagnostic and therapeutic norms applicable to post-HSCT BOS in children.
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