肠镜下分级对非血缘脐血移植后恶性血液病患者肠道急性移植物抗宿主病的预后评估价值  

The prognostic value of colonoscopy grading for acute graft-versus-host disease in patients with malignant hematological disorders after unrelated cord blood transplantation

作　　者：汪森林 孙光宇 朱小玉 徐雪梅 叶飞 李世兰 陈思 Wang Senlin;Sun Guangyu;Zhu Xiaoyu;Xu Xuemei;Ye Fei;Li Shilan;Chen Si(Department of Gastroenterology,The First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Department of Haematology,The First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China;Clinical Pathology Centre,The First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)消化内科,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)血液内科,合肥230001 [3]中国科学技术大学附属第一医院(安徽省立医院)临床病理中心,合肥230001

出　　处：《中华血液学杂志》2024年第5期462-467,共6页Chinese Journal of Hematology

基　　金：中央高校基本科研专项资金(WK9110000068)。

摘　　要：目的探讨肠镜下分级对非血缘脐血移植(UCBT)后出现肠道急性移植物抗宿主病(IT-aGVHD)的恶性血液病患者的预后评估价值。方法收集2016年6月至2023年6月在安徽省立医院进行UCBT后出现激素耐药的IT-aGVHD患者50例, 比较肠镜下黏膜损伤较轻组(27例, 肠镜下分级为Ⅰ、Ⅱ级)和较重组(23例, 肠镜下分级为Ⅲ、Ⅳ级)患者IT-aGVHD治疗的有效率、生存率等, 回顾性分析影响患者预后的因素。结果轻症组、重症组患者在肠镜检查后28 d有效率分别为92.6%和47.8%(P<0.001), 56 d有效率分别为81.5%和39.1%(P=0.002), 最优有效率分别为92.6%和65.2%(P=0.040), 差异均有统计学意义。多因素分析发现, 肠镜下分级是影响IT-aGVHD治疗有效率的独立危险因素。轻症组、重症组患者肠镜检查后2年的总生存率分别为70.4%(95%CI 52.0%~88.8%)和34.8%(95%CI 14.8%~54.8%), 差异有统计学意义(P=0.003)。多因素分析显示, 肠镜下分级、巨细胞病毒感染状态、二线治疗方案及患者的年龄是影响生存的独立危险因素。结论肠镜下黏膜损伤程度较轻组(Ⅰ、Ⅱ级)患者的治疗有效率和预后优于损伤程度较重组(Ⅲ、Ⅳ级)。Objective To investigate the prognostic value of enteroscopic grading for the prognostic assessment of patients with malignant hematological diseases who developed intestinal acute graft-versus-host disease(IT-aGVHD)after unrelated cord blood transplantation(UCBT).Methods Fifty patients with IT-aGVHD who developed hormone resistance after UCBT from June 2016 to June 2023 at Anhui Provincial Hospital were collected to compare the effective and survival rates of IT-aGVHD treatment in the group with milder enteroscopic mucosal injury(27 cases,enteroscopic grading ofⅠandⅡ)and the group with more severe injury(23 cases,enteroscopic grading ofⅢandⅣ)and to retrospectively analyze the factors affecting patients’prognosis.Results Patients in the mild and severe groups had an effective rate of 92.6%and 47.8%at 28 days after colonoscopy(P<0.001),81.5%and 39.1%at 56 days after colonoscopy(P=0.002),with optimal effective rate of 92.6%and 65.2%(P=0.040),respectively,and the differences were statistically significant.The multifactorial analysis found that enteroscopic grading was an independent risk factor affecting the effective rate of IT-aGVHD treatment.The overall survival rate at 2 years after colonoscopy was 70.4%(95%CI 52.0%-88.8%)and 34.8%(95%CI 14.8%-54.8%)for patients in the mild and severe groups,respectively,and the difference was statistically significant(P=0.003).Multifactorial analysis revealed that enteroscopic grading,cytomegalovirus infection status,second-line treatment regimen,and patients’age were independent risk factors for survival.Conclusion The treatment efficacy and prognosis of patients in the group with less severe enteroscopic injury(gradesⅠandⅡ)were better than those in the group with more severe injury(gradesⅢandⅣ).

关 键 词：脐血干细胞移植 移植物抗宿主病 结肠镜检查 

分 类 号：R733[医药卫生—肿瘤]