异基因造血干细胞移植后慢性肝脏移植物抗宿主病的危险因素及预后分析  

Risk Factors and Prognosis of Hepatic cGVHD after Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：于迪 韩雅慧 扈臣媛 张兵 张焕新 李护军 齐昆明 曹江 李振宇 闫志凌 徐开林 YU Di;HAN Ya-Hui;HU Chen-Yuan;ZHANG Bin;ZHANG Huan-Xin;LI Hu-Jun;QI Kun-Ming;CAO Jiang;LI Zhen-Yu;YAN Zhi-Ling;XU Kai-Lin(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院血液科,江苏徐州221002

出　　处：《中国实验血液学杂志》2018年第4期1174-1179,共6页Journal of Experimental Hematology

基　　金：国家自然科学基金(81500088);江苏省自然科学基金(BK20161178)资助

摘　　要：目的:探讨异基因造血干细胞移植(allo-HSCT)后并发肝脏cGVHD患者的危险因素及预后。方法:总结2013年1月至2016年12月期间在本院接受allo-HSCT的147例患者临床资料,回顾性分析患者性别、年龄、移植前疾病状态、HLA相合程度、供者性别、干细胞类型、GVHD预防方案中是否加用ATG、预处理期间肝功能异常、移植前HBsAg、急性GVHD与肝脏cGVHD发生的关系,并分析肝脏cGVHD与患者预后关系。结果:32例患者发生肝脏cGVHD,累积发生率26.4%。单因素分析移植前HBsAg^+及预处理期间肝功能异常均与肝脏cGVHD无明显相关(P>0.05),多因素分析显示,早期出现aGVHD(HR=2.087,P=0.045)是肝脏cGVHD的独立危险因素,加用ATG显著降低肝脏cGVHD的发生率(HR=0.231,P=0.000)。单因素分析发生肝脏cGVHD与未发生组相比患者移植后2年复发率较低(P=0.038)。结论:移植早期出现aGVHD是肝脏cGVHD发生的独立危险因素,ATG可以减少肝脏cGVHD的发生率。肝脏cGVHD患者移植后2年复发率相对低。Objective： To analyze the risk factors and prognosis of hepatic chronic GVHD after allogeneic hematopoietic stem cell transplantation（ allo-HSCT）. Methods： The clinical data of 147 patients undergoing allo-HSCT from January 2013 to December 2016 were analyzed,the correlation between recipient age and sex,disease state,matched degree of HLA,donor sex,stem cell sources,ATG in GVHD prophylaxis,liver dysfunction during conditioning period,pre-transplant HBsAg,prior aGVHD and hepatic cGVHD were studied,and the correlation between hepatic cGVHD and prognosis were analysed. Results： Thirty-two patients had hepatic cGVHD,cumulative incidence of 26. 4%. In univariate analysis,pre-transplant HBsAg ＋ and liver dysfunction during conditioning period were not significantly related with hepatic cGVHD（ P〈0. 05）. In multivariate analysis,prior acute GVHD（ HR = 2. 087,P =0. 045） was the independent risk factor for hepatic cGVHD,ATG（ HR = 0. 231,P = 0. 000） was significantly related with a lower incidence of hepatic cGVHD. In univariate analysis,patients with hepatic cGVHD had a lower 2 years relapse rate（ P = 0. 038）. Conclusion： Prior acute GVHD is the independent risk factor for hepatic cGVHD,the ATG can significantly reduce the incidence of hepatic cGVHD. Hepatic cGVHD has been found to relate with a lower 2 years relapse rate.

关 键 词：血液病 异基因造血干细胞移植 肝脏cGVHD 危险因素 预后分析 

分 类 号：R457.7[医药卫生—治疗学]