异基因造血干细胞移植后死亡原因分析  

Analysis on cause of death after allogeneic hematopoietic stem cell transplantation

作　　者：王莹[1] 樊星[1] 王苓[1] 唐暐[1] 胡炯[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,上海200025

出　　处：《内科理论与实践》2014年第4期270-273,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨移植前不同疾病状态的血液疾病患者异基因造血干细胞移植后死亡原因差异。方法:回顾性分析本院移植中心自2007至2011年进行异基因造血干细胞移植的血液系统疾病患者148例,按照移植前疾病是否获得完全缓解分为标危组(n=101)和高危组(n=47),分别比较复发死亡比例、移植后非复发死亡比例以及移植后非复发死亡原因的构成比。结果:移植后总生存率、复发率和非复发病死率分别为57.8%±4.5%、42.1%±6.1%和21.7%±3.6%。标危组复发病死率及移植相关非复发病死率均显著低于高危组(P<0.001,P=0.013)。标危组复发死亡占40.7%,移植相关非复发死亡占59.3%,其中感染50.0%,移植物抗宿主病31.3%,弥漫性肺泡出血25.0%,肝静脉闭塞病12.5%,植入不良12.5%,颅内出血6.3%;高危组复发死亡占51.7%,移植后非复发死亡占48.3%,其中感染50.0%,移植物抗宿主病35.7%,植入不良21.4%,肝静脉闭塞病14.3%,颅内出血14.3%。结论:移植前获得完全缓解患者移植后非复发死亡比例高于复发死亡比例,而非完全缓解患者相反。移植相关非复发死亡原因中,不论移植前疾病状态,感染和移植物抗宿主病都是最主要的死因。Objective To analysis the cause of death after allogeneic hematopoietic stem cell transplantation in patients with hematological diseases in different disease status. Methods A total of 148 patients who underwent allogeneic hematopoietic stem cell transplantation from 2007 to 2011 were enrolled in this retrospective analysis. According to the disease status before transplantation, patients were classified into standard-risk group （n=101） and highrisk group （n=47） in accordance with the occurrence of complete remission. The relapse related mortality rate, non-relapse related mortality rate and their composition ratio were analyzed. Results The overall survival rate, relapse related mortality rate and non-relapse related mortality rate were 57.8%±4.5%, 42.1%±6.1%, and 21.7%±3.6%, respectively. The relapse related mortality rate and non-relapse related mortality rate in the standard-risk group were significantly lower than those in high risk group. In standard risk group, relapse related mortality accounted for 40.7% of the death; and nonrelapse related mortality accounted for 59.3% of the death, among which infection accounted for 50.0%, graft-versus-host disease （GVHD） accounted for 31.3%, diffuse alveolar hemorrhage （DAH） accounted for 25.0%, veno-occlusive disease accounted for 12.5%, poor implantation accounted for 12.5%, intracranial hemorrhage accounted for 6.3%. In high-risk group, relapse related mortality accounted for 51.7% of the death; and non-relapse related mortality accounted for 48.3% of the death, among which infection accounted for 50.0%, GVHD accounted for 35.7%, poor implantation accounted for 21.4%, veno-occlusive disease accounted for 14.3%, and intracranial hemorrhage accounted for 14.3%. Conclusions Patients achieved complete remission before transplantation had more non-relapsed related mortality than relapse related mortality, while patients without complete remission were of the opposite. Regardless of achieving complete remission or not, infection and GVHD remained as

关 键 词：异基因造血干细胞移植 复发死亡 移植后非复发死亡 血液疾病 

分 类 号：R457.7[医药卫生—治疗学]