儿童造血干细胞移植后心包积液的临床分析  

Clinical analysis of the pericardial effusion after hematopoietic stem cell transplantation in children

作　　者：赵娜娜 肖玉华 刘璇[1] 卢艳玲 余鑫 冯晓勤[1] ZHAO Nana;XIAO Yuhua;LIU Xuan;LU Yanling;YU Xin;FENG Xiaoqin(Department of Pediatrics,Southern Hospital,Southern Medical University,Guangzhou,510515,China)

机构地区：[1]南方医科大学南方医院儿科,广州510515

出　　处：《临床血液学杂志》2024年第11期812-815,共4页Journal of Clinical Hematology

基　　金：南方医科大学南方医院2021年度临床研究专项(No:2021CR005)。

摘　　要：目的:分析儿童造血干细胞移植后大量心包积液的发病率、危险因素及预后。方法:选择2020年1月至2022年1月于我院儿科行异基因造血干细胞移植的156例(<18岁)儿童患者为研究对象。其中移植后发生中至大量心包积液的儿童患者9例,总结其心包积液的临床特征,统计中大量心包积液的发病率,分析危险因素及预后。结果:9例患儿发生了10例次中至大量心包积液,发病率为5.8%(95%CI 2.7%~10.7%),中位发生时间为149.5(7~312)天。8例(88.9%)为晚发型心包积液,中位发生时间为163.5(121~312)天。1例二次移植患儿发生2次心包积液,均在移植后20d内。8例晚发型心包积液中4例同时存在移植相关血栓性微血管病,5例发生不同程度肺部感染,3例在免疫抑制剂减量后发生中至大量心包积液,1例合并膀胱慢性移植物抗宿主病。9例患儿中7例并发胸腔积液和腹腔积液。8例患儿给予病因、对症等综合治疗,其中5例行心包穿刺引流,缓解后短期内均无复发。4例患儿死亡,死亡率为44.4%(95%CI 13.7%~78.8%),死因为重症肺炎、脓毒性休克或放弃治疗,而非心包积液。结论:本中心儿童造血干细胞移植后大量心包积液发病率为5.8%(95%CI 2.7%~10.7%),以晚发型为主。晚发型心包积液与移植相关血栓性微血管病、肺部感染及移植物抗宿主病有关。大量心包积液患儿死亡率高,但无一例直接死于心包填塞。Objective To analyze the incidence,risk factors and prognosis of large pericardial effusion after hematopoietic stem cell transplantation in children.Methods A total of 156 children(<18 years of age)who underwent allogeneic hematopoietic stem cell transplantation from January 2020 to January 2022 were selected as the study subjects.Nine pediatric patients had moderate to large pericardial effusion after transplantation.The clinical characteristics of their pericardial effusion were summarized,the incidence of large pericardial effusion was counted,and the risk factors and prognosis were analyzed.Results There were ten occurences of moderate to large pericardial effusion in nine patients,with an overall incidence of 5.8%(95%CI 2.7%-10.7%),and the median onset time of pericardial effusion was 149.5(7-312)days after transplantation.Eight of the nine cases(88.9%)had a late-onset pericardial effusion,with a median onset time of 163.5(121-312)days.One patient of secondary transplantation had two pericardial effusions,all within 20 days after transplantation.In eight patients with late-onset pericardial effusion,four patients had transplant-associated thrombotic microangiopathy,five patients had a pulmonary infection of varying degrees,three patients with moderate to large pericardial effusion after immunosuppressant reduction,and one patient had chronic bladder graft-versus-host disease.Seven of the nine cases were complicated by pleural effusion and abdominal effusion.Eight cases were treated with etiology and symptomatic treatment,five of which were treated with pericardial puncture and drainage,and no recurrence occurred in the short term after remission.Four cases died,with a mortality of 44.4%(95%CI 13.7%-78.8%),due to severe pneumonia,septic shock,or abandonment of treatment,rather than pericardial effusion.Conclusion The incidence of large pericardial effusion after pediatric allogeneic hematopoietic stem cell transplantation in our center was 5.8%(95%CI 2.7%-10.7%),mainly late-onset.Late-onset pericardial effus

关 键 词：造血干细胞移植 大量心包积液 心包填塞 儿童 

分 类 号：R457.7[医药卫生—治疗学]