异基因造血干细胞移植治疗重型再生障碍性贫血的临床研究  

A clinical study of allogeneic hematopoietic stem cell transplantation for the treatment of severe aplastic anemia

作　　者：杨小兰 潘耀柱 葸瑞 吴涛 张茜 周进茂 Yang Xiaolan;Pan Yaozhu;Xi Rui;Wu Tao;Zhang Qian;Zhou Jinmao(School of Clinical Medical,Ningxia Medical University,Yinchuan Ningxia 750000,China;Department of Hematology,the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou Gansu 730050,China)

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750000 [2]解放军联勤保障部队第九四〇医院血液科,甘肃兰州730050

出　　处：《中国医刊》2024年第8期882-886,共5页Chinese Journal of Medicine

基　　金：甘肃省卫生健康行业科研计划项目(No:GSWSKY-2019-63);西北民族大学高校项目(31920230195);甘肃省创新基地与人才计划项目(21JR7RA015)。

摘　　要：目的探讨异基因造血干细胞移植(allo-HSCT)治疗重型再生障碍性贫血(SAA)/极重型再生障碍性贫血(vSAA)的疗效,并比较接受单倍体相合造血干细胞移植(HID-HSCT)与同胞全相合造血干细胞移植(MSDHSCT)患者的生存情况。方法回顾性分析2013年1月至2022年12月于解放军联勤保障部队第九四〇医院采用allo-HSCT治疗的66例SAA/vSAA患者的临床资料,根据供者情况分为HID-HSCT组(40例)和MSD-HSCT组(26例)。分析66例患者的造血重建、移植物抗宿主病(GVHD)、移植后并发症发生情况并比较两组患者的生存情况。结果66例SAA/vSAA患者中,63例患者达到造血重建,造血重建率为95.45%,3例未达到造血重建的患者死于脓毒血症及消化道出血。移植后中性粒细胞植入时间为11~21 d,中位植入时间15 d,血小板植入时间为11~28 d,中位植入时间16 d。31例发生急性移植物抗宿主病(aGVHD),累积发病率为47.0%,其中Ⅰ/Ⅱ度aGVHD 23例,Ⅲ/Ⅳ度aGVHD 8例。23例发生上呼吸道感染,34例患者发生不同程度的肺部感染,4例发生皮下软组织感染,7例发生泌尿系感染,7例发生肠道感染,6例发生颅内感染,14例发生脓毒血症,14例发生EB病毒血症,20例发生巨细胞病毒血症;3例患者移植后出现重度肠道GVHD合并消化道出血,1例移植后血象持续不恢复并发脓毒血症、消化道出血死亡,1例在造血重建后发生感染继发血小板减低出现颅内出血,2例移植后由于重度感染和aGVHD继发脑出血;9例移植后出现(迟发型)出血性膀胱炎,3例发生移植后EB病毒相关淋巴增殖性疾病,3例发生血栓性微血管病,1例发生血栓性微血管病肾损伤,6例发生继发性低免疫球蛋白血症。截至2023年7月1日,共存活48例,死亡18例,5年预计总生存率为76.1%,HID-HSCT组与MSD-HSCT组5年预计总生存率分别为73.5%和80.0%,经比较差异无统计学意义(P=0.59)。结论Allo-HSCT是治愈SAA的有效方法,其中MSD-HSCT效果好,移Objective To investigate the effi cacy of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of SAA/vSAA,and to compare the survival of haploidentical donor-hematopoietic stem cell transplantation(HID-HSCT)with matched sibling donor-hematopoietic stem cell transplantation(MSD-HSCT).Method The clinical data of 66 SAA/vSAA patients treated with allo-HSCT in the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army from January 2013 to December 2022 were retrospectively analyzed,and they were divided into 40 cases in HID-HSCT group and 26 cases in MSD-HSCT group according to the donor situation.Hematopoietic reconstruction,graft versus host disease(GVHD)and postoperative complications of 66 patients were analyzed and the survival of the two groups were compared.Result Among 66 SAA/vSAA patients,63 patients achieved hematopoietic reconstruction,the rate of hematopoietic reconstruction was 95.45%,and 3 patients who did not achieve hematopoietic reconstruction died of sepsis and gastrointestinal hemorrhage.The median implantation time of neutrophil was 15 days and the median implantation time of platelet was 16 days and 11 to 28 days after transplantation.Acute graft versus host disease(aGVHD)occurred in 31 patients,with a cumulative incidence of 47.0%,including 23 cases with gradeⅠ/ⅡaGVHD and 8 cases with gradeⅢ/ⅣaGVHD.There were 23 patients with upper respiratory tract infection,34 patients with different degrees of lung infection,4 patients with subcutaneous soft tissue infection,7 patients with urinary tract infection,7 patients with intestinal infection,6 patients with intracranial infection,14 patients with sepsis,14 patients with Epstein-Barr viremia,and 20 patients with cytomegaloviremia.3 patients developed severe intestinal GVHD combined with gastrointestinal hemorrhage after transplantation,1 patient died of sepsis and gastrointestinal hemorrhage after continuous non-recovery of blood image after transplantation,1 patient suffered intracrania

关 键 词：重型再生障碍性贫血 异基因造血干细胞移植 单倍体移植 造血重建 移植物抗宿主病 

分 类 号：R551[医药卫生—血液循环系统疾病]