预处理前输血对异基因造血干细胞移植疗效的影响  

The clinical effect of transfusion before transplantation conditioning on patients of allogeneic hematopoietic stem cell transplantation

作　　者：刘宴成[1] 陈宝安[1] 高冲[1] 孙雪梅[2] 丁家华[1] 孙耘玉[1] 赵刚[1] 王骏[1] 宋慧慧[1] 鲍文[1] 马燕[1] Schmitt A Schmitt M 

机构地区：[1]东南大学附属中大医院血液科,江苏南京210009 [2]南京市鼓楼医院血液科,江苏南京210008 [3]乌尔姆大学临床医学院内科,德国乌尔姆89081

出　　处：《现代医学》2007年第3期171-174,共4页Modern Medical Journal

基　　金：江苏省自然科学基金资助项目(BK1999126);江苏省卫生厅科技发展基金资助项目(H200344);江苏省135医学工程重点学科基金资助项目(K0613);南京市重大课题基金资助项目(YQ0008);东南大学附属中大医院重大课题基金资助项目(2003YJ02)

摘　　要：目的探讨预处理前输注血制品对恶性血液病患者异基因造血干细胞移植术后造血功能恢复和急性移植物抗宿主病（aGVHD）发生情况的影响。方法对23例恶性血液病患者行异基因造血干细胞移植术治疗，其中8例于预处理前3个月内有输注血制品史，15例未输。移植过程中常规行aGVHD防治，观察预处理前输注血制品对患者异基因造血干细胞移植术后造血恢复及aGVHD发生情况的影响。结果预处理前输血组中性粒细胞恢复的中位时间为11．5d（11-16d），血小板恢复的中位时间为12．5d（11-16d）；预处理前未输血组中性粒细胞恢复的中位时间为13d（11-17d），血小板恢复的中位时间为13d（9-35d）；两组的造血功能恢复时间差异无统计学意义（均P〉0．05）。预处理前输血组有75％（6／8）的患者发生aGVHD，其中Ⅰ度3例，Ⅲ度1例，超急性（hGVHD）2例；未输血组有60％（9／15）患者发生aGVHD，其中Ⅰ度3例，Ⅱ度3例，Ⅲ度2例，Ⅳ度1例；两组aGVHD发生率差异有统计学意义（P=0．001）。发生aGVHD的患者经治疗均得到有效控制。结论恶性血液病异基因造血干细胞移植患者在移植前短期内输血对造血干细胞的植人及造血功能恢复未产生明显影响，但会增加aGVHD发生的可能性，对这部分患者应加强aGVHD的防治。Objective To investigate the clinical effect of transfusion before transplantation conditioning on patients of allogeneie stem cell transplantation. Methods Twenty-three cases of hematologic malignancies underwent allogeneic stem cell transplantation,8 cases had transfusion within 3 months before transplantation conditioning, 15 cases had not. Prevention and treatment of GVHD were done conventionally. Acute graft-versus-host disease（ aGVHD ）and hematopoietic recovery were observed. Results In transfusion group, the median recovery time of neutrophil and platelet was 11.5 d（ 11 - 16 d） and 12.5 d（ 11 - 16 d） respectively. In the group without transfusion,the median recovery time of neutrophil and platelet was 13 d（ 11 - 17 d）and 13 d （9 d - 35 d）respectively. There were no significant difference between the two groups （all P 〉 0.05 ）. In transfusion group, 75 % cases had aGVHD,grade Ⅰ 3 cases,gradeⅢ lcase,hGVHD 2 cases. In the group without transfusion,60% cases had aGVHD, grade 3 cases, gradeⅡ3 cases, grade Ⅲ 2 cases, grade Ⅳ 1 case. There was a significant difference in the percentage of aGVHD between the two groups（P =0. 0001 ）. The probability of aGVHD in transfusion group was larger,aGVHD occurred in the patients was well controlled after treatment. Conclusion Transfusion within short time before transplantation conditioning has no effect on blood recovery, but the probability of aGVHD is larger. The patients of transfusion before conditioning should be emphasis on prevention and treatment of aGVHD.

关 键 词：输血 造血干细胞移植 异基因 预处理 恶性血液病 造血恢复 急性移植物抗宿主病 

分 类 号：R735.34[医药卫生—肿瘤]