异基因造血干细胞移植的中枢神经系统并发症危险因素分析  

Analysis of the risk factors of central nervous system complications after allogeneic hematopoietic stem cell transplantation

作　　者：韩利杰[1] 马红霞[1] 董秀娟[1] 王娴静[1] 焦雪丽[1] 陈蕾[1] 赵晓武[1] 

机构地区：[1]郑州市第三人民医院血液科,450000

出　　处：《白血病．淋巴瘤》2012年第11期671-673,677,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨异基因造血干细胞移植（allo—HSCT）后中枢神经系统（CNS）并发症的病因、临床特点及高危因素。方法观察68例allo—HSCT患者CNS并发症的发生情况及特点，并分析其原因和高危因素。结果69例患者allo—HSCT后6个月内8例发生CNS并发症，发生率11．6％。其中CNS并发症发生率在HLA,全相合及不全相合组分别为4．9％（2／41）和21．4％（6／28）（P〈0．05），在合并移植物抗宿主病（GVHD）≤2度和〉2度组分别为6．7％（4／9）、44．4％（4／60）（P〈0．01）。CNS并发症在年龄≤14岁和〉14岁组、用或未用抗人胸腺球蛋白组、疾病稳定或进展组、预处理含或不含白消安组各组内比较差异均无统计学意义（均P〉0．05）。allo—HSCT最常见的CNS并发症是癫痫和颅内感染，其次为颅内出血。结论allo．HSCT中HLA配型不全相合及发生GVHD〉2度均是发生CNS并发症的高危因素；癫痫、颅内感染和颅内出血是allo—HSCT常见的CNS并发症。Objective To analyse the etiology, clinical characteristics and risk factors of central nervous system （CNS） complications after allogeneie hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical features of CNS complications in patients who underwent allo-HSCT were observed, and analysis its causes and risk factors. Results 8 cases of CNS complications oceured in 69 patients within 6 months after allo-HSCT and the incidence was 11.6 %, the occurrence rate of CNS complications was 21.4 % （6/28） in HLA mismatched group, higher than HLA matched group [4.9 % （2/41）] （P 〈 0.05）. Analogously, the incidence was 44.4 % （4/60） in patients with graft-versus-host disease （GVHD） （〉grade 2）, which was significantly higher than patients with 2 or below grade 2 GVHD [6.7 % （4/9）] （P 〈 0.01）. But there was no significant difference in the incidence of CNS complications between ~〈 14 years old and 〉14 years old, with or without ATG, different stages of diseases, whether pretreatment with maryland respectively （P 〉 0.05）, either. Epilepsy and intracranial infection were the most common CNS complications in allo-HSCT, followed by intraeranial hemorrhage. Conclusion HLA mismatched and above grade 2 GVHD are the risk factors of CNS complications in allo-HSCT. Epilepsy,intracranial infection and bleeding are common CNS complications in allo-HSCT.

关 键 词：造血干细胞移植 中枢神经系统 并发症 

分 类 号：R457[医药卫生—治疗学]