异基因造血干细胞移植后并发出血性膀胱炎的危险因素分析  

Analysis of the Risk Factors for He morrhagic Cystitis after Hematopoietic Stem Cell Transplantation

作　　者：孙春红[1] 王晓宁[1] 罗敏娜 郭彩利[1] 祁仕环 张倍榕 王芳[1] 张欢 贺鹏程[1] SUN Chun-Hong;WANG Xiao-Ning;LUO Min-Na;GUO Cai-Li;QI Shi-Huan;ZHANG Bei-Rong;WANG Fang;ZHANG Huan;HE Peng-Cheng(Department of Hematology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院血液内科,陕西西安710061

出　　处：《中国实验血液学杂志》2021年第2期610-614,共5页Journal of Experimental Hematology

摘　　要：目的:分析异基因造血干细胞移植(allo-HSCT)后并发出血性膀胱炎(HC)的危险因素。方法:回顾性分析2010年1月-2018年12月于西安交通大学第一附属医院行allo-HSCT的153例患者的临床资料。观察HC的发生率、发生中位时间及治疗转归。利用多因素分析观察患者性别、年龄、诊断、移植前疾病状态、移植类型、预处理方案中是否含有ATG、预处理方案中是否含有CTX、干细胞来源、中性粒细胞植入时间、血小板植入时间、CMV感染、EBV感染、BKV感染、急性移植物抗宿主病(a GVHD)是否为发生HC的高危因素。结果:153例allo-HSCT患者中,25例发生HC,发生率为16.34%,发生的中位时间为31 d,治疗后全部好转,无1例遗留膀胱刺激症状及膀胱挛缩。经单因素和多因素Logistic回归分析,结果显示,移植类型、预处理中含ATG、CMV血症以及a GVHD 4项因素(R值分别为1.036、3.234、3.298、2.817)是HC的独立危险因素。结论:HC患者尿BKV检测均为阳性,主要发生在移植后13-56 d。HLA配型半相合、含ATG的预处理方案、CMV血症及a GVHD是allo-HSCT后发生HC的独立危险因素。Objective:To analyze the risk factors affecting hemorrhagic cystitis(HC)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical data of 153 patients underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Xi’an Jiaotong University from January 2010 to December 2018 were selected and retrospectively analyzed.The incidence,median time and treatment outcome of HC should be observed.Multivariate analysis was used to observe the risk factors of HC in patients,including sex,age,diagnosis,disease status before transplantation,transplantation type,ATG and CTX in the pretreatment scheme,stem cell source,neutrophil and platelet implantation time;CMV,EBV and BKV infection,and acute graft-versus-host disease(aGVHD).Results:Among 153 patients underwent allogeneic hematopoietic stem cell transplantation,25(16.34%)patients had HC,the median occurance time was 31 days,all patients achieved complete remission after treatment,no bladder irritation and bladder contracture were left.The results of univariate and multivariate Logistic regression analysis showed that the type of transplantation,ATG,CMV viremia before treatment,aGVHD(r=1.036,3.234,3.298 and2.817,respectively)were the independent risk factors of HC.Conclusion:The urinary BKV detections in the patients with HC are positive,mainly occured during the period from day+13 to days+56.HLA haplotype,pretreatment including ATG,and CMV viremia,and aGVHD are the independent risk factors for HC after allo-HSCT.

关 键 词：造血干细胞移植 出血性膀胱炎 危险因素 

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