造血干细胞移植后胸腔漏气综合征15例临床分析  

Clinical analysis of 15 cases of thoracic air-leak syndrome after hematopoietic stem cell transplantation

作　　者：兰学立[1] 李海潮[2] 王静波[3] 顾江英[3] 于海涛[4] 薛松[3] 张书芹[3] 张永平 刘新民[1] Lan Xueli;LiHaichao;Wang Jingbo;Gu Jiangying;Yu Haitao;Xue Song;Zhang Shuqin;Zhang Yongping;Liu Xinmin(Department of Geriatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院老年科,100034 [2]北京大学第一医院呼吸内科,100034 [3]航天中心医院血液科 [4]航天中心医院影像科

出　　处：《北京医学》2019年第4期253-257,共5页Beijing Medical Journal

摘　　要：目的总结造血干细胞移植(hematopoietic stem cell transplantation, HSCT)后发生胸腔漏气综合征(thoracic air-leak syndromes, TALS)的临床特征,并分析其对预后的影响。方法回顾性分析2012年1月至2017年12月在航天中心医院就诊行HSCT治疗后发生TALS的患者的住院资料,并进行随访,统计分析TALS对HSCT预后的影响及其相关因素。结果接受HSCT治疗的582例患者中,15例(2.6%)发生TALS,男11例,女4例,年龄11～54岁,平均(26±12)岁。发生TALS的肺部基础疾病包括非感染性疾病11例,其中闭塞性细支气管炎综合征(bronchiolitis obliterans syndrome, BOS)5例、BOS合并特发性肺炎综合征(idiopathic pneumonia syndrome, IPS)3例、IPS 3例;肺部感染4例。首次TALS距HSCT时间63～790 d,平均(325±247)d。随访15～61个月,生存4例,死亡11例。其中肺部非感染性疾病相关TALS患者死亡10例(10/11),感染相关TALS死亡1例(1/4)。BOS患者死亡4例(4/5),平均生存时间(139±25)d;IPS 3例患者全部死亡,平均生存时间(25±15)d;IPS合并BOS 3例患者全部死亡,平均生存时间(49±46)d。发生TALS的5例BOS患者总体生存率明显低于未发生TALS的18例BOS患者,差异有统计学意义(P=0.0093)。结论 TALS是HSCT预后不良的独立危险因素。BOS并发TALS较IPS并发TALS生存期长,发生TALS的BOS患者的预后较未发生TLAS者更差。Objective To summarize the clinical features of thoracic air-leak syndrome(TALS)after hematopoietic stem cell transplantation(HSCT),and to analyze the impact of TALS on the HSCT prognosis.Methods The patients diagnosed with TALS after HSCT in Aero Space Center Hospital from January 2012 to December 2017 were retrospectively investigated.The impacts of TALS on HSCT prognosis and its related factors were statistically analyzed.Results Among the 582 patients treated with HSCT,15(2.6%)developed TALS,including 11 males and four females,aged 11-54 years,with an average age of(26±12)years old.The primary lung diseases of these TALS patients included 11 cases of non-infectious lung diseases and four cases of pulmonary infectious.The non-infectious diseases group included five cases of bronchiolitis obliterans syndrome(BOS),three cases of BOS with idiopathic pneumonia syndrome(IPS),and three cases of IPS.The onset of TALS after HSCT ranged from 63 to 790 days,with an average of(325±247)days.During the 15 to 61 months follow-up,four patients survived and 11 patients died.Of the 11 patients who died,one(1/4)patient was in pulmonary infectious group,10(10/11)patients were in non-infectious lung group.Four patients(4/5)in BOS group died,with an average survival time of(139±25)days.Three patients(3/3)in IPS group died,with an average survival time of(25±15)days.Three patients(3/3)patients in IPS combined BOS group died,with an average survival time of(49±46)days.The overall survival rate of the five patients with BOS who developed TALS was significantly lower than that of the 18 BOS patients without TALS(P=0.009 3).Conlusions TALS is an independent risk factor for poor prognosis of HSCT.Patients with BOS complicated by TALS has a longer survival time than those with IPS complicated by TALS,and the prognosis of BOS patients with TALS has a worse prognosis than BOS patients without TALS.

关 键 词：胸腔漏气综合征 造血干细胞移植 闭塞性细支气管炎综合征 特发性肺炎综合征 

分 类 号：R457.7[医药卫生—治疗学]