重型再生障碍性贫血造血干细胞移植后受者性腺及生育功能分析  

Analysis of gonad and reproductive function of recipients after hematopoietic stem cell transplantation in severe aplastic anemia

作　　者：郭雅芳 马梁明 朱秋娟 贡蓉 高志林 田卫伟 王涛 Guo Yafang;Ma Liangming;Zhu Qiujuan;Gong Rong;Gao Zhilin;Tian Weiwei;Wang Tao(Department of Hematology,Shanxi Bethune Hospital,the Third Hospital of Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西白求恩医院山西医科大学第三医院血液内科,太原030032

出　　处：《中华器官移植杂志》2021年第12期744-749,共6页Chinese Journal of Organ Transplantation

基　　金：山西省重点研发计划(201803D31144);山西省科技成果转化引导专项(201604D131005)。

摘　　要：目的比较两种预处理方案对重型再生障碍性贫血(SAA)行单倍体造血干细胞移植受者的疗效、性腺及生育功能的影响。方法回顾性分析行单倍体造血干细胞移植73例SAA受者资料,预处理方案分为:氟达拉滨+环磷酰胺+抗胸腺细胞球蛋白组(FClowATG组,45例)和白消安+环磷酰胺+抗胸腺细胞球蛋白组(BuCy/ATG组,28例)。比较两组受者血细胞植入时间、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、睾酮等指标的变化,对移植后受者的妊娠与生育功能进行随访观察。结果两组血细胞植入时间差异无统计学意义(P=0.096;P=0.133)。BuCy/ATG组女性受者的FSH、LH水平较FClowATG组高,雌二醇水平较FClowATG组低,组间差异均有统计学意义(均P<0.05)。BuCy/ATG组女性受者妊娠或生育率比FClowATG组低,差异均有统计学意义(均P<0.05)。两组中男性受者FSH、LH、睾酮和生育率的差异无统计学意义(均P>0.05)。两组受者2年总存活率和无失败存活率差异无统计学意义(P=0.091;P=0.084)。结论FClowATG可能是SAA行单倍体造血干细胞移植有效、对性腺及生育功能损害较小的预处理方案。Objective To compare the effects of two pretreatment schemes on the efficacy,gonad and reproductive function of haploid hematopoietic stem cell transplantation recipients with severe aplastic anemia(SAA).Methods The data of 73 patients with SAA who underwent haploid hematopoietic stem cell transplantation were analyzed retrospectively.The pretreatment scheme was divided into Fludarabine+Cyclophosphamide+Antithymocyte globulin group(FClowATG group,45 cases)and Busulfan+Cyclophosphamide+Antithymocyte globulin group(Bucy/ATG group,28 cases).The changes of blood cell implantation time,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol and testosterone were compared between the two groups.Results there was no significant difference in blood cell implantation time between the two groups(P=0.096;P=0.133).The levels of FSH and LH in female recipients in Bucy/ATG group were higher than those in FClowATG group,and the level of estradiol was lower than that in FClowATG group.There were significant differences between the groups(all P<0.05).The pregnancy or fertility rate of female recipients in Bucy/ATG group was lower than that in FClowATG group(all P<0.05).There was no significant difference in FSH,LH,testosterone and fertility between the two groups(all P>0.05).There was no significant difference in 2-year overall survival rate and failure free survival rate between the two groups(P=0.091;P=0.084).Conclusions FClowATG may be an effective pretreatment scheme for haploid hematopoietic stem cell transplantation in SAA with less damage to gonad and reproductive function.

关 键 词：造血干细胞移植 再生障碍性贫血 受者预处理 生育力 

分 类 号：R556.5[医药卫生—血液循环系统疾病]