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目的:建立一种治疗闭塞性细支气管炎综合症(BOS)的新方案,并初步观察其安全性和有效性。方法:7例HSCT后确诊的BOS病例,分别给予脐带间充质干细胞(MSC)1×10~6/kg,静脉输注1次/周,4周共4次;阿奇霉素0.25 g口服1次/隔日;布地奈德福莫特罗粉吸入剂4.5μg,3次/天,如患者出现呼吸衰竭,则给予甲泼尼龙1mg/(kg·d),维持2周,之后激素快速减量,至治疗后4周,甲泼尼龙减至0.25 mg/(kg·d)。之后,根据患者慢性移植物抗宿主病情况,调整激素用量。结果:在治疗过程中未出现严重并发症。除1例患者合并心衰治疗无效死亡外,另外6例患者肺功能指标包括FEV1,FEV1/FVC,PaO_2和AaDO_2均在6个月后得到显著改善(P<0.05)。结论:MSC联合布地奈德福莫特罗和阿奇霉素治疗BOS是安全的,并可在一定程度上减少激素用量,提高患者的生存质量。
Objective: To establish a new scheme for the treatment of occlusive bronchiolitis syndrome (BOS) and to observe its safety and efficacy. Methods: Seven cases of BOS diagnosed after HSCT were treated with 1 × 10 ~ 6 / kg umbilical cord mesenchymal stem cells (MSC) once a week for 4 weeks and intravenous infusion of azithromycin 0.25 g once daily for 4 weeks. The other day, budesonide formoterol powder inhalation 4.5μg, 3 times a day, if patients with respiratory failure, then given methylprednisolone 1mg / (kg · d), for 2 weeks, after the rapid reduction of hormone, to Four weeks after treatment, methylprednisolone reduced to 0.25 mg / (kg · d). Later, according to patients with chronic graft versus host disease, adjust the amount of hormones. Results: No serious complications occurred during the course of treatment. Except one patient died of failure of heart failure, the other six pulmonary function indexes including FEV1, FEV1 / FVC, PaO_2 and AaDO_2 were significantly improved after 6 months (P <0.05). Conclusion: The combination of budesonide formoterol and azithromycin in the treatment of BOS is safe and can reduce the dosage of hormones to a certain extent and improve the quality of life of patients.