肥胖对异基因造血干细胞移植效果的影响  

Effect of obesity on the efficacy of allogeneic hematopoietic stem cell transplantation

作　　者：沈星 朱晗[1] 陈睿泽 吴汉新[1] 陆化[1] 陈丽娟[1] 钱思轩[1] 朱雨[1] 李建勇[1] 缪扣荣[1] Shen Xing;Zhu Han;Chen Ruize;Wu Hanxin;Lu Hua;Chen Lijuan;Qian Sixuan;Zhu Yu;Li Jianyong;Miao Kourong(Department of Hematology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029

出　　处：《白血病．淋巴瘤》2021年第9期529-533,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金(81470329)。

摘　　要：目的探讨肥胖对异基因造血干细胞移植效果的影响。方法回顾性分析南京医科大学第一附属医院2017年8月至2020年9月行异基因造血干细胞移植的81例患者临床资料。根据体质量指数(BMI)分为肥胖组(BMI≥28 kg/m^(2),11例)和非肥胖组(BMI<28 kg/m^(2),70例),比较两组患者临床病理特征、造血干细胞植入、移植后并发症、生存及复发等情况。采用Cox比例风险回归模型进行单因素、多因素生存分析。结果81例患者中位随访时间280 d(8~1218 d),1年总生存(OS)率77.9%,1年无进展生存(PFS)率73.8%。非肥胖组与肥胖组1年OS率分别为82.6%和46.2%(χ^(2)=15.54,P<0.01),1年PFS率分别为82.1%和36.4%(χ^(2)=15.56,P<0.01),非复发死亡(NRM)率分别为7.1%和32.7%(χ^(2)=6.463,P=0.01),累积复发率分别为11.5%和42.9%(χ^(2)=8.146,P=0.004)。非肥胖组和肥胖组中性粒细胞植入时间、血小板植入时间、急性移植物抗宿主病、慢性移植物抗宿主病、出血性膀胱炎、巨细胞病毒感染及EB病毒感染发生情况比较,差异均无统计学意义(均P>0.05)。多因素分析结果显示,肥胖是异基因造血干细胞移植患者OS的独立不良影响因素(HR=3.814,95%CI 1.343~10.827,P=0.012)。结论肥胖是异基因造血干细胞移植后患者生存的重要不良影响因素,改善这部分患者的疗效及生存值得进一步研究探讨。Objective To investigate the effect of obesity on the efficacy of allogeneic hematopoietic stem cell transplantation.Methods The clinical data of 81 patients who underwent allogeneic hematopoietic stem cell transplantation from August 2017 to September 2020 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.According to the body mass index(BMI),the patients were divided into the obese group(BMI≥28 kg/m^(2),11 cases)and the non-obese group(BMI<28 kg/m^(2),70 cases).The clinicopathological characteristics,hematopoietic stem cell implantation,post-transplantation complications,survival and recurrence were compared between the two groups.Univariate and multivariate survival analyses were performed by using Cox proportional hazards regression model.Results The median follow-up time of 81 patients was 280 d(8-1218 d).The 1-year overall survival(OS)rate was 77.9%,and the 1-year progression-free survival(PFS)rate was 73.8%.The 1-year OS rates of the non-obese group and the obese group were 82.6%and 46.2%(χ^(2)=15.54,P<0.01),and the 1-year PFS rates were 82.1%and 36.4%(χ^(2)=15.56,P<0.01).The non-recurrence mortality(NRM)rates of the non-obese group and the obese group were 7.1%and 32.7%(χ^(2)=6.463,P=0.01),and the cumulative recurrence rate was 11.5%and 42.9%(χ^(2)=8.146,P=0.004).Between the non-obese group and the obese group,the median engraft time of neutrophils and platelets,acute graft-versus-host disease,chronic graft-versus-host disease,hemorrhagic cystitis,cytomegalovirus infection and Epstein-Barr virus infection had no statistical difference(P>0.05).The result of multivariate analysis showed that obesity was an independent adverse influencing factor for OS of patients with allogeneic hematopoietic stem cell transplantation(HR=3.814,95%CI 1.343-10.827,P=0.012).Conclusion Obesity is an important unfavorable factor that affects patient's survival after allogeneic hematopoietic stem cell transplantation,and the improvement of the efficacy and survival of these patient

关 键 词：造血干细胞移植 肥胖 预后 

分 类 号：R457.7[医药卫生—治疗学]