外周血干细胞移植中出血性膀胱炎的病因与防治  

Study on hemorrhagic cystitis in peripheral blood stem cell transplantation recipients

作　　者：郭超[1] 章卫平[1] 王健民[1] 倪雄[1] 丁晓勤[1] 

机构地区：[1]第二军医大学长海医院血液科,上海200433

出　　处：《第二军医大学学报》2002年第9期949-951,共3页Academic Journal of Second Military Medical University

基　　金：上海市卫生系统百名跨世纪优秀学科带头人培养计划资助项目 (98BR0 2 9)

摘　　要：目的 :观察外周血干细胞移植 (PBSCT)中出血性膀胱炎 (HC)的发病情况 ,探讨其发病原因及防治效果。方法 :1996年 5月至 2 0 0 2年 5月采用 PBSCT治疗各类血液病 80例 ,其中异基因移植 5 0例 ,自体移植 30例。预处理方案为 CTX 12 0mg/ kg(+VP16 2 0 mg/ kg) +TBI 6 .5～ 8.0 Gy。 HC的预防随机分成 2组 :A组 (38例 )采用常规水化、碱化 ;B组 (4 2例 )在常规水化、碱化基础上加用美司钠 ,用法为 CTX后 0、4、8h各静推 1次 ,每次剂量为每日 CTX总量的 2 0 %。结果 :80例患者中共有 10例出现 HC(12 .5 %) ,均为迟发性 , 度 5例 , 度 4例 , 度 1例。 A组有 8例出现 HC(2 1.1%) ;B组仅有 2例 HC(4 .8%,P<0 .0 5 ) ;异基因移植组有 9/ 5 0出现 HC(18.0 %) ,自体移植组仅有 1/ 30 (3.3%,P<0 .0 5 ) ;急性移植物抗宿主病(GVHD)阳性组出现 HC为 7/ 2 0 (35 .0 %) ,而阴性组仅为 2 / 30 (6 .7%,P<0 .0 5 )。 5例病毒感染者中 3例发生 HC。治疗上除充分补液、碱化尿液和加强利尿外 ,加用前列腺素 E1 脂微球制剂 (L ipo PGE1 ) ,有病毒感染者予阿昔洛韦或更昔洛韦治疗。全部病例经上述处理均获痊愈。结论 :HC的发生除 CTX等药物损害外 ,还与 GVHD及病毒感染有关 ;在常规水化、碱化基础上加用美司钠可有效降低Objective:To study hemorrhagic cystitis (HC) in the peripheral blood stem cell transplantation (PBSCT) recipients.Methods:From May 1996 to May 2002,80 patients with hematological malignancies received allogeneic PBSCT (n=50) and autogeneic PBSCT(n=30).Conditioning regimen was TBI(6.5-8.0 Gy) plus CTX (120 mg/kg) and VP16(20 mg/kg).The patients were divided into group A (n=38) and group B(n=42) randomly.Group A received hyperhydration and alkalinizing,group B received hyperhydration and alkalinizing plus infusion mesna at 0,4 and 8 h after CTX infusion with 20% of the CTX.Results:Among the 80 patients,10 patients (12.5%) developed late-onset HC(5 grade Ⅰ,4 Ⅱ and 1 Ⅲ)with a median onset time of 32 d after PBSCT.The incidence of HC in group B (4.8%) was significantly lower than that in group A (21.1%) (P<0.05).The incidence of HC was 9/50 (18.0%)in the allo-PBSCT group,1/30(3.3%)in the auto-PBSCT (P<0.05),7/20(35.0%) in the acute GVHD positive group,and 2/30 (6.7%) in the GVHD negative group (P<0.05).Among 5 patients with viruses (ADV,CMV and EBV) infection,3 developed HC.Hyperhydration,alkalinizing and diuresis plus Lipo prostaglandin E 1 (Lipo PGE 1) or anti-virus drug were the main treatment measure,and all patients were cured.Conclusion:The risk factors of HC are GVHD and virus infection as well as CTX.Both hyperhydration and mesna are effective in preventing HC.However,the use of mesna can significantly lower HC incidence.Besides hyperhydration,alkalinizing and diuresis,Lipo PGE 1 or anti-virus drug may be effective in the treatment of HC.

关 键 词：病因 防治 造血干细胞移植 外周血 出血性膀胱炎 美司钠 

分 类 号：R694.3[医药卫生—泌尿科学]