异基因造血干细胞移植后出血性膀胱炎发生危险因素分析  

Analysis of the risk factors for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

作　　者：李莹[1] 杨隽[1] 许晓倩 黄崇媚 邱慧颖 魏道林[1] 蔡宇[1] 万理萍[1] 宋献民[1] 童茵[1] LI Ying;YANG Jun;XU Xiaoqian;HUANG Chongmei;QIU Huiying;WEI Daolin;CAI Yu;WAN Liping;SONG Xianmin;TONG Yin(Department of Hematology,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院血液科,上海200080

出　　处：《内科理论与实践》2020年第5期326-331,共6页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation, allo-HSCT)后出血性膀胱炎(hemorrhagic cystitis,HC)发生的危险因素,为HC的预防和治疗提供临床依据。方法:对2018年1月至2020年1月在本院完成allo-HSCT的188例患者的病例资料进行回顾性分析。选择影响allo-HSCT后HC发生的相关临床参数进行单因素和多因素分析。结果:HC的发生率为20.7%(39/188),中位年龄41岁。尿BK病毒(BK virus, BKV)阳性检出率76.9%(30/39)。轻度HC 33例,重度HC 6例。HC发生的中位时间为30(-269) d,其中38例为迟发型HC,1例为早发型HC,HC中位持续时间为16(582) d。巨细胞病毒(cytomegalovirus,CMV)血症(P=0.000)以及急性移植物抗宿主病(acute graft versus host disease, aGVHD)(P=0.006)是HC发生的独立危险因素。结论:定期检测CMVDNA,积极有效的抗病毒治疗是预防HC发生的有效措施。积极有效地预防和治疗aGVHD是预防HC的发生、促进HC恢复的有效措施。Objective To analyze the risk factors of hemorrhagic cystitis(HC)after allogeneic hematopoietic stem cell transplantation(allo-HSCT)and provide clinical evidence for the prevention and treatment of HC.Methods The HC of 188 patients after allo-HSCT in our hospital from January 2018 to January 2020 was analyzed retrospectively.The clinical parameters related to HC after allo-HSCT were selected to perform univariate and multivariate analysis.Results The incidence of HC was 20.7%(39/188),with a median age of 41 years.In the HC patients,there was 33 mild cases and 6 severe ones and the positive rate of urine BK virus(BKV)was 76.9%(30/39).The median time of HC occurrence was 30(-2-69)d,including 38 delayed HC and 1 early HC,and the median duration of the disease was 16(5-82)d.Cytomegalovirus(CMV)viremia and acute graft versus host disease(aGVHD)are independent risk factors for HC.Conclusions Regular detection of CMV-DNA and active antivirotic treatment are effective measures to prevent the occurrence of HC.In addition,active prevention and treatment of aGVHD also can prevent the occurrence of HC and promote the recovery from HC.

关 键 词：异基因造血干细胞移植 出血性膀胱炎 巨细胞病毒血症 急性移植物抗宿主病 

分 类 号：R457.7[医药卫生—治疗学] R694.3[医药卫生—临床医学]