造血干细胞移植相关中枢神经系统并发症临床分析  

Clinical study of central nervous system complications associated with hematopoietic stem cell transplantation

作　　者：胡通林[1] 商臻 曹阳[2] 张义成[2] 孟凡凯[2] 杨漾 王珏[2] 张东华[2] 赖林静 刘姗[1] 葛杭萍 肖毅[2] Hu Tonglin;Shang Zhen;Cao Yang;Zhang Yicheng;Meng Fankai;Yang Yang;Wang Jue;Zhang Donghua;Lai Linjing;Liu Shan;Ge Hangping;Xiao Yi(Department of Hematology,First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China;Department of Hematology,Tongji Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]浙江中医药大学附属第一医院浙江省中医院血液内科,杭州310006 [2]华中科技大学同济医学院附属同济医院血液内科,武汉430030

出　　处：《中华器官移植杂志》2023年第11期675-681,共7页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(82070213、81873444);浙江中医药科技计划项目(2022ZQ03)。

摘　　要：目的探讨造血干细胞移植(hematopoietic stem cell transplantation,HSCT)相关中枢神经系统(central nervous system,CNS)并发症的影响因素及预后。方法回顾性分析华中科技大学同济医学院附属同济医院血液科2019年1月1日至2021年8月31日住院的550例HSCT受者资料,根据是否发生CNS并发症分为CNS组(24例)和非CNS组(526例),分析比较两组受者的临床资料和预后。分析CNS并发症发生的影响因素,并对差异有统计学意义的指标进行多因素logistic回归分析,对预后相关因素如年龄、性别、疾病危险度等进行Cox回归分析。结果550例受者中330例为异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT),220例为自体造血干细胞移植(Autologous hematopoietic stem cell transplantation,auto-HSCT),共有24例受者(4.36%)发生CNS并发症,其中4例发生了2种CNS并发症。并发症的类型包括颅内感染8例(28.57%),移植相关血栓性微血管病(thrombotic microangiopathy,TMA)6例(21.43%),中枢肿瘤侵犯4例(14.29%),颅内出血4例(14.29%),脑白质病2例(7.14%),不明原因脑病4例(14.29%)。Logisitic回归分析CNS并发症的影响因素,结果显示:血小板植入时间(β=0.084,OR=1.088,P=0.048)、CMV感染(β=1.295,OR=3.65,P=0.008)与HSCT受者CNS并发症的发生呈正相关,年龄(β=-0.052,OR=0.949,P=0.004)与HSCT受者CNS并发症的发生呈负相关。24例发生CNS并发症的受者9例(37.50%)死亡,其中3例颅内感染,3例脑出血,2例TMA,1例不明原因脑病。血小板植入时间是HSCT受者发生CNS并发症预后不良的独立危险因素。结论年龄、CMV感染、血小板植入时间均是发生HSCT后CNS并发症的相关因素。血小板植入时间是HSCT受者发生CNS并发症预后不良的独立危险因素。Objective To explore the risk factors and outcomes of central nervous system(CNS)complications associated with hematopoietic stem cell transplantation(HSCT).Methods A total of 550 recipient after HSCT in the department of hematology of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 12019 to August 312021were enrolled.According to the occurrence of CNS complications,they were divided into the CNS group(24 cases)and the non CNS group(526 cases).The clinical information and prognosis were compared.We further analyzed the risk factors associated with CNS complications,and conducted multivariate logistic regression on statistically significant indicators.Cox regression analysis is conducted on prognostic factors such as age,gender and risk degree.Results A total of 550 recipients were enrolled,of which 330 underwent allo-HSCT,and others received auto-HSCT.A total of 24 cases(4.36%)had CNS complications,of which 4 cases had 2 types of CNS complications.The type of CNS complications included intracranial infection(8 cases,28.57%),transplantation-associated thrombotic microangiopathy(TA-TMA)(6 cases,21.43%),central tumor invasion(4 cases,14.29%),intracranial hemorrhage(4 cases,14.29%),leucodystrophy(2 cases,7.14%)and unexplained encephalopathy(4 cases,14.29%).Logistic regression analysis of risk factors related to CNS complications showed that,Platelet implantation time(β=0.084,OR=1.088,P=0.048),CMV infection(β=1.295,OR=3.65,P=0.008)is positively correlated with the occurrence of CNS complications in HSCT recipients but age(β=-0.052,OR=0.949,P=0.004)is negatively correlated with it.Nine of the 24 cases(37.50%)who experienced CNS complications died,including 3 cases of intracranial infection,3 cases of cerebral hemorrhage,2 cases of TMA,and 1 case of unexplained encephalopathy.Platelet implantation time is an independent risk factor for poor prognosis of CNS complications in HSCT recipients.Conclusions Our results indicated that,age,CMV infection and p

关 键 词：造血干细胞移植 中枢神经系统 并发症 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R457.7[医药卫生—临床医学]