摘要
目的 探讨异基因造血干细胞移植（allo-HSCT）后严重的（≥Ⅱ度）出血性膀胱炎（HC）的危险因素。方法 对1997年4月至2004年12月期间的114例allo-HSCT患者的资料进行回顾性分析。以预处理实施之日为观察起点，至移植后＋180 d随访中止。选择11个临床参数，即：年龄、性别、疾病类型、供者类型、预处理方案、移植时疾病状态、急性移植物抗宿主病（aGVHD）、aGVHD的预防、预处理方案中抗胸腺细胞球蛋白（ATG）的应用、中性粒细胞及血小板植活时间做Cox单因素分析。将在单因素分析中P＜0.1作为有统计学意义的因素进行Cox多因素回归分析。移植后180 d内HC累计发生率的计算应用Kaplan-Meier法。结果 （1）114例患者中有29例发生HC，＋180 d内HC的累计发生率为26％，其中Ⅱ级12例，Ⅲ级11例，Ⅳ级6例。（2）单因素分析表明，以下因素与HC的发生密切相关；男性（RR=2.885，P=0.021）、年龄≤25岁（RR=3.265，P=0.002）、Ⅲ～Ⅳ度aGVHD（RR=4.039，P=0.002）、非血缘供者（RR=4．347，P=0.000）、加强的GVHD预防方案（RR=2.218，P=0.045）、疾病进展期（RR=2.668，P=0.009）。（3）对上述有统计学意义的因素进行Cox多因素分析，只有男性（RR=2.993，95％CI 1.218～7.358；P=0.017）和非血缘供者（RR=4.478，95％CI 2.049～9.786；P=0.000）为HC的独立危险因素。结论 男性受者和非血缘供者的造血干细胞移植后发生HC的危险性显著增加。
Objective To analyze the risk factors of clinically overt hemorrhagic cystitis （HC） （ grade≥Ⅱ） in 114 patients undergoing allogeneic hematopoietic stem cell transplantation （allo-HSCT） to predict the occurrence of HC. Methods We retrospectively analyzed 29 cases of clinically overt HC from a series of 114 patients subject to allo-HSCT from April 1997 to December 2004. The time of follow-up began from the day of initiating conditioning to day 180 post-transplant. The 11 clinical parameters were selected for univariate analysis using a Cox regression： age, sex, underlying disease, conditioning regimen, disease status at transplant, aGVHD, donor type, use of ATG, GVHD prophylaxis, platelet and neutrophil engraftment. Factors that were significant at the 0.1 level on univariate analysis were evaluated by multivariate analysis using a Cox regression. The cumulative incidence of grade ≥Ⅱ HC within the day 180 after transplantation was calculated by the method of Kaplan and Meier. Results Twenty-nine out of 114 patients （26% ） developed HC with grade Ⅱ in 12/29 cases （41.4%）, grade Ⅲ in 11/29 cases （37.9%） and grade Ⅳ in 6/29 cases （20.7%）.The following factors were associated with an increased risk of HC by univariate analysis. male gender （RR=2.885, P=0.021）, younger than 26 years （RR = 3.265, P = 0.002）, gradeⅢ～Ⅳ aGVHD （RR = 4.039, P = 0.002）, unrelated donor （RR = 4.347, P = 0.000）, intense GVHD prophylaxis （RR= 2.218, P= 0.045）, advanced disease （RR= 2.668, P= 0.009）. These risk factors were entered into a multivariate model. Only male gender （RR= 2.993, 95% CI 1.218-7.358; P= 0.017） and unrelated donor （RR= 4.478, 95% CI 2.049-9.786; P= 0.000） were identified as being significantly associated with the occurrence of HC. Conclusion In multivariate analysis, patients were at increased risk of HC if they were male or had received grafts from unrelated donors.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2006年第6期337-340,共4页
Chinese Journal of Organ Transplantation
关键词
造血干细胞移植
膀胱炎
回归分析
Hematopoietic stem cell transplantation
Cystitis
Regression analysis
