中藥治療改善急性移植物對抗宿主疾病之腸胃症狀－－住院會診病例報告

Improvement of Gastrointestinal Symptoms of Acute Graft-Versus-Host Disease by Traditional Chinese Medicine-Case Report of Hospitalization Consultation

急性移植物對抗宿主疾病(Acute graft-versus-host disease, aGVHD)可發生於任何接受過異體血液幹細胞移植的患者，其症狀常在移植後數個月之內顯現，包括皮膚（皮膚斑丘疹、毒性表皮壞死症）、腸胃道（腹部絞痛、嚴重黏液型腹瀉、噁心、嘔吐）和肝臟（黃疸、肝臟發炎、疼痛性肝腫大）器官的受損，其發病迅速，攻勢猛烈，損傷多個器官，類似中醫「熱毒之邪」致病特點。本病例為一名63歲男性患者，因急性骨髓性白血病接受異體周邊血液幹細胞移植後，出現水樣性腹瀉已一個多月，伴隨間歇性發燒、多處口腔潰瘍和皮膚乾燥起紅疹，經診斷為急性移植物對抗宿主反應，接受清熱解毒和疏肝解鬱中藥治療約一個月後，患者大便質地由原本水樣稀糊狀改善為質乾略成形糞便，改善病人不適症狀及生活品質。

Acute graft-versus-host disease (aGVHD) is a common syndrome that occurs in patients who receive an allogeneic hematopoietic cell transplant (allo-HCT). The symptoms including skin manifestations (pruritic or painful maculopapular rashes), gastrointestinal manifestations (diarrhea, abdominal pain, nausea, vomiting) and hepatic injury (jaundice, hepatitis, hepatomegaly) often show up after hematopoietic cell transplant for several months. It breaks out quickly with fierce attack that damages several organs similar to ＂heat-toxicity＂ in Chinese medicine theory. This case report presented that a 63-year-old male received allogeneic peripheral blood stem cell transplantation due to acute myeloid leukemia in Taipei Veterans General Hospital. After allo-HCT, watery diarrhea accompanied with intermittent fever, multiple oral ulcers and skin rashes developed for one month. aGVHD was diagnosed but symptoms of aGVHD could not relieve even western medicine given. We prescribed heat-clearing and de-toxicating remedy combined with herbs that disperse stagnated Liver Qi for intermittent fever and gastrointestinal symptoms of aGVHD. Intermittent fever was subsided and watery diarrhea dried out to be moderate formed stool after taking Chinese herbal remedy for one month. Chinese herbal medicine ameliorated patient’s discomfort and improved life quality of patients with aGVHD in this report.