异基因造血干细胞移植后严重环孢素A相关神经毒性16例的回顾性分析  

A clinical retrospective analysis of the past five years of severe cyclosporine A-related neurotoxicity after allogeneic hematopoietic stem cell transplantation

作　　者：徐雪丹 秦芳梅[1] 周红升[1] 江千里[1] 张钰[1] 范志平[1] 马庆辉[1] 刘启发[1] 孙竞[1] 

机构地区：[1]南方医科大学南方医院血液科,广州510515

出　　处：《中华器官移植杂志》2014年第10期615-620,共6页Chinese Journal of Organ Transplantation

摘　　要：目的探讨近5年使用新型三唑类抗真菌药以来异基因造血干细胞移植（allo-HSCT）后严重环孢素A相关神经毒性（SNCT）的发生率、临床特征及其影响因素。方法回顾分析2008年6月至2013年6月间390例接受allo—HSCT的受者资料，其中16例（4．1％，16／390）发生SNCT，观察其临床表现、影像学特征、治疗及转归。结果SNCT患者主要表现为症状性癫痫，6例伴高血压，12例伴电解质紊乱，12例出现环孢素A浓度升高，13例合并使用新型三唑类药物。10例接受磁共振检查患者中7例显示异常，其中4例呈现脑后部可逆性脑病综合征影像。6例脑脊液检查患者中3例有轻度异常。16例经环孢素A停药或减量后，11例获得完全恢复，2例部分恢复，3例因SNCT死亡，SNCT相关死亡率为18．75％（3／16），移植后SNCT患者总体存活率为50％（8／16）。结论环孢素相关神经毒性是allo-HSCT后并不少见、进展迅猛的严重并发症之一，磁共振和电解质指标可协助快速诊断；建议环孢素A与新型三唑类药物合用时，应严密监测环孢素A的浓度；提高SNCT早期诊断的意识与积极处理移植早期并发症可能有助降低SNCT相关死亡率。Objective To investigate the incidence, clinical characteristics and the influencing factors of severe cyclosporine A （CsA）-related neurotoxicity （SNCT） in the patients after allogeneic hematopoietic stem cell transplantation （allo-HSCT） in the past five years. Method A retrospective analysis of 16 SNCT patients was carried out on 390 allo-HSCT recipients from June 2008 to June 2013. The clinical manifestations, imaging characteristics, treatment and outcome were observed. Result 4. 1% （16/390） were identified to have SNCT, mainly for symptomatic epilepsy, including hypertension （n = 6）, electrolyte imbalance （n = 12）, elevated CsA concentration （n = 12）, and combined use of novel triazole drugs （n = 13）. MRI performed on 10 patients after SNCT showed that 7 patients was abnormal, including 4 cases of PRES. CSF examination in 6 patients showed that there patients had mild abnormalities. After withdrawal or extenuation of CsA, 11 patients had complete recovery, two had partial recovery and three died of SNCT. SNCT-related mortality was 18. 75% （3/ 16） and overall survival was 50% （8/16）. Conelusion SNCT is not common, rapid progress and one of the most severe complications after allo-HSCT, MRI and electrolyte indicators can facilitate early diagnosis. It is recommended to closely monitor the concentration of CsA when combining CsA and novel triazole drugs. Raising awareness of early diagnosis of SNCT and taking active management of early transplant complications may help reduce the SNCT-related mortality.

关 键 词：造血干细胞移植 环孢素A 神经毒性 三唑 

分 类 号：R457.7[医药卫生—治疗学]