白血病异基因造血干细胞移植术后股骨坏死的影响因素  

Influencing factors of femoral head necrosis after allogeneic hematopoietic stem cell transplantation in leukemia

作　　者：何甘霖 陈香侬 李萍 甄佳怡 李京霞 邹外一[1] 许多荣[1] He Ganlin;Chen Xiangnong;Li Ping;Zhen Jiayi;Li Jingxia;Zou Waiyi;Xu Duorong(Department of Hematology,The First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院血液内科,广州510080

出　　处：《中华关节外科杂志(电子版)》2024年第4期450-456,共7页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨恶性血液病患者异基因造血干细胞移植(Allo-HSCT)后股骨头坏死的影响因素。方法回顾性收集2016年1月至2021年12月中山大学附属第一医院血液内科接受异基因造血干细胞移植后出现股骨头/股骨远端坏死的患者各项临床资料及检查结果,纳入临床资料完整,排除资料缺失或随访时间较短的患者。最终纳入移植前后体重、移植前后血红蛋白、移植后血钙波动情况、移植后膀胱炎、移植物抗宿主病、激素用量等18个可能的影响因素,将性别相同、年龄相近、随访日期相近的患者,按1∶3进行配对logistic回归分析。结果共纳入40例患者,单因素logistic回归分析:膀胱炎[比值比(OR)=5.967,95%置信区间(CI)(1.209,29.443),P=0.028]、移植后半年应用甲泼尼龙剂量[OR=2.108,95%CI(1.008,4.408),P=0.048]、移植后血钙极差(即移植后血钙最大值-最小值)[OR=2.377,95%CI(1.127,5.014),P=0.023]有统计学意义;多因素logistic回归分析,仅移植后血钙极差的差异有统计学意义[OR=2.377,95%CI(1.127,5.014),P=0.023]。结论血钙移植后极差大是白血病患者AIIo-HSCT术后股骨头坏死发生的潜在危险因素。Objective To investigate the influencing factors of osteonecrosis of the femoral head(ONFH)in patients with hematologic malignancies after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Data of leukemia patients who underwent allo-HSCT in the Department of Hematology at the First Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2021 were retrospectively collected.The patients with complete clinical data were enrolled,while the patients with incomplete data or short-term follow-up time were excluded.A total of 40 patients were included,and 18 potential influencing factors were analyzed using logistic regression with 1:3 matched design based on gender,age,and disease status during the same period.Results In the univariate logistic regression analysis,statistically significant factors for ONFH included cystitis[odds ratio(OR)=5.967,95%confidence interval(CI)(1.209,29.443),P=0.028],methylprednisolone dosage at six months after transplantation[OR=2.108,95%CI(1.008,4.408),P=0.048],and extreme difference in serum calcium after transplantation(i.e.,the difference between the maximum and minimum values of blood calcium after transplantation)[OR=2.377,95%CI(1.127,5.014),P=0.023].In the multivariate logistic regression analysis,only the extreme difference in blood calcium levels after transplantation remained statistically significant[OR=2.377,95%CI(1.127,5.014),P=0.023].Conclusion A large difference in blood calcium levels after transplantation is a risk factor for ONFH in leukemia patients undergoing allo-HSCT.

关 键 词：造血干细胞移植 股骨头坏死 LOGISTIC模型 

分 类 号：R733.3[医药卫生—肿瘤]