异基因造血干细胞移植后并发慢性移植物抗宿主病患者生活质量变化及其影响因素分析  

The variation and impact factors of quality of life in chronic graft versus host disease patients after allogeneic hematopoietic stem cell transplantation

作　　者：赵晶 丁淑怡 周晓瑜[1] 章建丽[1] 许丽炜[1] 张力晨 严佳丽 程琼 刘念 金爱云[1] Zhao Jing;Ding Shwyi;Zhou Xiaoyu;Zhang Jianli;Xu Liwei;Zhang Lichen;Yan Jiali;Cheng Qiong;Liu Nian;Jin Aiyun(Bone Marrow Transplantationafter allogeneic hematopoietic stem cell transplantation;Department of Thoracic Surgery,the First Affiliated Hospital of Zhejiang University,School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院骨髓移植中心,杭州310003 [2]浙江大学医学院附属第一医院普胸外科,杭州310003

出　　处：《中华移植杂志（电子版）》2022年第3期153-159,共7页Chinese Journal of Transplantation(Electronic Edition)

基　　金：浙江省卫生健康科技计划项目(2021KY668)。

摘　　要：目的探究异基因造血干细胞移植(allo-HSCT)后并发慢性移植物抗宿主病(cGVHD)患者生活质量及其影响因素。方法选取2016年6月至2020年6月于浙江大学医学院附属第一医院骨髓移植中心行allo-HSCT并在移植后诊断为cGVHD的患者作为研究对象,研究时间为allo-HSCT后初次诊断cGVHD至确诊后9个月。收集allo-HSCT后并发cGVHD患者确诊cGVHD时以及确诊后3、6和9个月临床资料,并采用第4版癌症治疗功能评价-骨髓移植测评量表(FACT-BMT V4.0)对其进行问卷调查。非正态分布计量资料采用Kruskal-Wallis H检验进行比较。分类变量采用卡方检验进行比较。对allo-HSCT并发cGVHD患者确诊后3个月生活质量影响因素进行单因素分析,选取单因素分析中P<0.05的因素及患者年龄进行多元线性回归分析。P<0.05为差异有统计学意义。结果最终纳入247例allo-HSCT后并发cGVHD患者,其中111例为轻度cGVHD,104例为中度cGVHD,32例为重度cGVHD,三组患者原发病及移植时间构成比例差异均有统计学意义(χ^(2)=15.446和44.456,P均<0.05)。轻、中、重度cGVHD组患者躯体状况、社会/家庭状况、情感状况、功能状况、干细胞移植模块得分以及FACT-BMT V4.0总分差异均有统计学意义(H=41.184、16.277、22.695、27.014、60.112和64.645,P均<0.05)。截至2021年6月,247例allo-HSCT后并发cGVHD患者中位随访时间为948(246,1867)d,其中68.4%(169/247)患者经系统治疗后获得完全缓解(CR)/部分缓解(PR)。获得CR/PR患者确诊cGVHD时以及确诊后3、6、9个月FACT-BMT V4.0总分分别为152(111,183)、124(95,154)、129(100,157)和152(120,182)分,各时间点差异有统计学意义(H=344.113,P<0.05)。单因素及多元线性回归分析结果显示,cGVHD严重程度及糖皮质激素耐药是影响allo-HSCT后并发cGVHD患者确诊后3个月生活质量独立危险因素(P均<0.05)。结论FACT-BMT V4.0在allo-HSCT人群中具有较好的实践价值。cGVHD严重影响allo-HSCT后患�Objective To investigate the quality of life and its impact factors in patients with chronic graft versus host disease(cGVHD)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Patients who developed cGVHD following allo-HSCT treatment at the Bone Marrow Transplantation Center,the First Affiliated Hospital of Zhejiang University,School of Medicine from June 2016 to June 2020 were enrolled.The investigating periods was from the initial diagnosis of cGVHD to 9 months after diagnosis.We collected the characteristics of patients at the time of diagnosis of cGVHD and 3,6,9 months after diagnosis.The functional assessment of cancer treatment-bone marrow transplant(FACT-BMT V4.0)was measured at the time of diagnosis of cGVHD and 3,6,9 months after diagnosis.Non-normal distribution continuous variables were analyzed using Kruskal-Wallis H test.Categorical covariates were analyzed using the Chi-square test.Univariate analysis was used to analyze the impact factors of quality of life of patients at 3 months after diagnosis of cGVHD.Factors with P<0.05 in univariate analysis and age of patients were selected for multiple liner regression analysis.P<0.05 was considered statistically significant.Results A total of 247 patients with cGVHD after allo-HSCT were enrolled,including 111 patients with mild cGVHD,104 patients with moderate cGVHD,and 32 patients with severe cGVHD.There were significant differences in the proportion of primary diseases and transplantation periods among the 3 groups(χ^(2)=15.446 and 44.456,all P<0.05).There were significant differences in physical status,social/family status,emotional status,functional status,stem cell transplantation module scores and FACT-BMT V4.0 total scores among mild,moderate and severe cGVHD groups(H=41.184,16.277,22.695,27.014,60.112 and 64.645,all P<0.05).The median follow-up time of 247 patients with cGVHD after allo-HSCT was 948(246,1867)d at the last follow-up.And 68.4%(169/247)of cGVHD patients achieved complete response(CR)/partial response(PR)afte

关 键 词：异基因造血干细胞移植 慢性移植物抗宿主病 生活质量 影响因素 

分 类 号：R733[医药卫生—肿瘤] R457.7[医药卫生—临床医学]