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中华细胞与干细胞杂志(电子版)

中华细胞与干细胞杂志(电子版) ›› 2026, Vol. 16 ›› Issue (02) : 102 -109. doi: 10.3877/cma.j.issn.2095-1221.2026.02.005

综述

异基因造血干细胞移植后植入功能不良的研究进展
吴卓茜, 范圣瑾†()   
  1. 150001　哈尔滨，黑龙江哈尔滨医科大学附属第一医院血液内科
  • 收稿日期:2025-09-02 出版日期:2026-04-01
  • 通信作者: 范圣瑾

Research progress in poor graft function after allogeneic hematopoietic stem cell transplantation

Zhuoxi Wu, Shengjin Fan†()   

  1. Department of Hematology, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
  • Received:2025-09-02 Published:2026-04-01
  • Corresponding author: Shengjin Fan
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吴卓茜, 范圣瑾. 异基因造血干细胞移植后植入功能不良的研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(02): 102-109.

Zhuoxi Wu, Shengjin Fan. Research progress in poor graft function after allogeneic hematopoietic stem cell transplantation[J/OL]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2026, 16(02): 102-109.

异基因造血干细胞移植（allo-HSCT）后植入功能不良（PGF）是影响患者预后的重要并发症，常导致感染，增加出血风险。其发生与供者干细胞功能缺陷、造血微环境损伤及免疫失调等机制密切相关。目前治疗策略主要包括间充质干细胞输注、CD34+细胞回输和二次移植，以及他汀类药物和造血生长因子等药物干预，修复微环境、促进造血重建。本文就发生机制与治疗等方面研究进展进行综述。

关键词: 异基因造血干细胞移植, 植入功能不良, 影响因素, 病理生理机制

Poor graft function (PGF) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a severe post-transplant complication affecting patient prognosis, which often leads to infections and an elevated risk of hemorrhagic events. The pathogenesis of PGF is multifactorial, involving mechanisms such as functional impairment of donor-derived stem cells, injury to the bone marrow microenvironment, and dysregulation of immune homeostasis. Current therapeutic strategies for PGF include mesenchymal stem cell infusions, CD34+ cell reinfusion, secondary transplantation as well as drug intervention such as statins and hematopoietic growth factors, repairing the microenvironment and promoting hematopoietic reconstitution. This article reviews the recent advances in understanding the pathophysiological mechanisms and therapeutic management of PGF.

Key words: Allogeneic hematopoietic stem cell transplantation, Poor graft function, Influencing factors, Pathophysiological mechanisms
表1 植入功能不良相关鉴别诊断
鉴别对象 病理基础 临床特征 实验室/检查发现 鉴别核心 主要诊断依据
原发病复发 恶性克隆重新出现 原发病相关表现 骨髓形态学、流式细胞术检测到恶性克隆；嵌合状态为混合或受者嵌合率升高 存在恶性克隆，非骨髓造血衰竭 骨髓检查、嵌合状态分析
移植物抗宿主病 移植物免疫攻击宿主靶器官 皮肤、口腔、胃肠道等靶器官受累表现 靶器官受累的临床表现和病理学证据 免疫攻击导致的特异性靶器官损害，无骨髓增生低下 临床表现、靶器官活检
药物毒性/病毒活动性感染 直接骨髓抑制/炎症因子风暴 与用药史或感染相关的表现 病原学检测阳性，或明确的毒性药物使用史 有明确外部诱因（药物/感染） 用药史、病原学检测
移植相关血栓性微血管病 血管内皮损伤所致微血管病性溶血、血栓形成 微血管病性溶血、血栓形成，多器官功能损害 乳酸脱氢酶升高、结合珠蛋白降低、血小板消耗性减少、外周血破碎红细胞 溶血证据（破碎红细胞、乳酸脱氢酶升高等）及多系统受累 溶血指标、血涂片、器官功能评估
毛细血管渗漏综合征 毛细血管内皮损伤，液体外渗 急性期血液浓缩；重症/后期全身水肿、低蛋白血症、低血压 血液浓缩或稀释性血细胞减少，伴低蛋白血症 血细胞减少与液体转移（浓缩或稀释）相关，非骨髓造血衰竭 临床表现、血流动力学及蛋白水平
肝窦阻塞综合征 肝血窦流出道阻塞，内皮损伤 疼痛性肝肿大、黄疸、腹水 肝功能异常，门脉高压表现；影像学（超声/CT）可见肝肿大、腹水等 血细胞减少与门脉高压、脾功能亢进及肝功能受损相关，有特征性肝病表现 临床表现、影像学检查
图1 PGF病理生理机制注：ROS为活性氧；PGF为植入功能不良；GVHD为移植物抗宿主病；CMV为巨细胞病毒；HSC为造血干细胞
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