摘要
目的:探讨异基因造血干细胞移植(allo-HSCT)后并发肝脏cGVHD患者的危险因素及预后。方法:总结2013年1月至2016年12月期间在本院接受allo-HSCT的147例患者临床资料,回顾性分析患者性别、年龄、移植前疾病状态、HLA相合程度、供者性别、干细胞类型、GVHD预防方案中是否加用ATG、预处理期间肝功能异常、移植前HBsAg、急性GVHD与肝脏cGVHD发生的关系,并分析肝脏cGVHD与患者预后关系。结果:32例患者发生肝脏cGVHD,累积发生率26.4%。单因素分析移植前HBsAg^+及预处理期间肝功能异常均与肝脏cGVHD无明显相关(P>0.05),多因素分析显示,早期出现aGVHD(HR=2.087,P=0.045)是肝脏cGVHD的独立危险因素,加用ATG显著降低肝脏cGVHD的发生率(HR=0.231,P=0.000)。单因素分析发生肝脏cGVHD与未发生组相比患者移植后2年复发率较低(P=0.038)。结论:移植早期出现aGVHD是肝脏cGVHD发生的独立危险因素,ATG可以减少肝脏cGVHD的发生率。肝脏cGVHD患者移植后2年复发率相对低。
Objective： To analyze the risk factors and prognosis of hepatic chronic GVHD after allogeneic hematopoietic stem cell transplantation（ allo-HSCT）. Methods： The clinical data of 147 patients undergoing allo-HSCT from January 2013 to December 2016 were analyzed,the correlation between recipient age and sex,disease state,matched degree of HLA,donor sex,stem cell sources,ATG in GVHD prophylaxis,liver dysfunction during conditioning period,pre-transplant HBsAg,prior aGVHD and hepatic cGVHD were studied,and the correlation between hepatic cGVHD and prognosis were analysed. Results： Thirty-two patients had hepatic cGVHD,cumulative incidence of 26. 4%. In univariate analysis,pre-transplant HBsAg ＋ and liver dysfunction during conditioning period were not significantly related with hepatic cGVHD（ P〈0. 05）. In multivariate analysis,prior acute GVHD（ HR = 2. 087,P =0. 045） was the independent risk factor for hepatic cGVHD,ATG（ HR = 0. 231,P = 0. 000） was significantly related with a lower incidence of hepatic cGVHD. In univariate analysis,patients with hepatic cGVHD had a lower 2 years relapse rate（ P = 0. 038）. Conclusion： Prior acute GVHD is the independent risk factor for hepatic cGVHD,the ATG can significantly reduce the incidence of hepatic cGVHD. Hepatic cGVHD has been found to relate with a lower 2 years relapse rate.
作者
于迪
韩雅慧
扈臣媛
张兵
张焕新
李护军
齐昆明
曹江
李振宇
闫志凌
徐开林
YU Di;HAN Ya-Hui;HU Chen-Yuan;ZHANG Bin;ZHANG Huan-Xin;LI Hu-Jun;QI Kun-Ming;CAO Jiang;LI Zhen-Yu;YAN Zhi-Ling;XU Kai-Lin(Department of Hematology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2018年第4期1174-1179,共6页
Journal of Experimental Hematology
基金
国家自然科学基金(81500088)
江苏省自然科学基金(BK20161178)资助
关键词
血液病
异基因造血干细胞移植
肝脏cGVHD
危险因素
预后分析
hematological disease
allogeneic hematopoietic stem cell transplantation
hepatic cGVHD
risk factor
prognosis analysis
