儿童造血干细胞移植后的肺功能动态变化分析  

Dynamic changes in pulmonary function after pediatric haematopoietic stem cell transplantation

作　　者：赵晓威 李洪娟[2] 顾艳[2] 赵羽琦 冷颜丽 王红美[2] ZHAO Xiaowei;LI Hongjuan;GU Yan;ZHAO Yuqi;LENG Yanli;WANG Hongmei(College of Clinical Medicine of Jining Medical University,Jining 272067,Shandong,China;Department of Pediatrics Hematology,the First Affiliated Hospital of Shandong First Medical University,Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272067 [2]山东第一医科大学第一附属医院(山东省千佛山医院)小儿血液科,山东济南250014

出　　处：《中国现代医生》2025年第8期33-36,共4页China Modern Doctor

基　　金：山东省齐鲁干细胞工程有限公司项目(QLSC01202023008)。

摘　　要：目的探讨异基因儿童造血干细胞移植(hematopoietic stem cell transplantation,HSCT)后的肺功能动态变化,并比较良性与恶性血液病患儿的肺功能差异。方法选取2015年6月至2023年12月在山东第一医科大学第一附属医院接受异基因HSCT患儿233例作为研究对象,按原发病分为良性病组(n=142),恶性病组(n=91)。收集患儿移植前及术后3、6、9、12、18、24个月的肺功能检查数据,分析其动态变化轨迹。结果良性病组患儿的一秒钟用力呼气量(forced expiratory volume in one second,FEV1)在移植后6个月达最低后恢复,恶性病组在9个月达最低(P<0.001);FEV1/用力肺活量(forced vital capacity,FVC)于第18个月达最低值后回升(P<0.001)。恶性病组患儿的FEV1、FEV1/FVC、肺总量(total lung capacity,TLC)及一氧化碳弥散量(carbon monoxide diffusing capacity,DLCO)在多数时间点低于良性病组(P<0.05)。DLCO降低为最常见异常。Kaplan-Meier分析结果显示,移植后前3个月的FEV1、FEV1/FVC、FVC变化斜率为负者更易发生限制性通气功能障碍,FEV1/FVC斜率为负者的阻塞性通气功能障碍风险增高(P<0.05)。结论儿童异基因HSCT后肺功能异常普遍存在,恶性病组患儿的肺功能参数低于良性病组,且恢复较慢;移植后前3个月的肺功能变化斜率为负者更易发生肺功能障碍。Objective To investigate the dynamic changes in pulmonary function after allogeneic hematopoietic stem cell transplantation(HSCT)in children and compare pulmonary function differences between children with benign and malignant hematological diseases.Methods A total of 233 children who underwent allogeneic HSCT in the First Affiliated Hospital of Shandong First Medical University,Shandong Provincial Qianfoshan Hospital from June 2015 to December 2023 were selected as subjects,according to the original disease,children were divided into benign group(n=142)and malignant group(n=91).Pulmonary function examination data were collected pre-transplant and at 3,6,9,12,18 and 24 months post-transplant,dynamic trajectories of pulmonary function parameters were analyzed.Results Forced expiratory volume in one second(FEV1)recovered after reaching its lowest in benign group in 6th month post-transplantation,while in malignant group in 9th month(P<0.001).FEV1/forced vital capacity(FVC)reached its lowest value in 18th month and then recovered(P<0.001).FEV1,FEV1/FVC,total lung capacity(TLC)and carbon monoxide diffusing capacity(DLCO)were significantly lower in malignant group than those in benign group at most time points(P<0.05).Reduced DLCO was most common abnormality.Kaplan-Meier analysis showed that those with negative slopes of FEV1,FEV1/FVC,and FVC changes in first 3 months post-transplantation were more likely develop to restrictive ventilatory disorder,and those with negative FEV1/FVC slopes had a significantly higher risk of obstructive ventilatory disorder(P<0.05).Conlusion Pulmonary dysfunction is prevalent in children after allogeneic HSCT.Pulmonary function parameters of children in malignant group were significantly lower than those in benign group and children recovery was slower.Patients with negative slopes of pulmonary function changes in the first 3 months after post-transplantation are more likely develop to pulmonary dysfunction.

关 键 词：造血干细胞移植 肺功能 儿童血液病 

分 类 号：R725.5[医药卫生—儿科]