Leung A Y H, Mak R, Lie A K W, Yuen K Y, Cheng V C C, Liang R, Kwong Y L
University Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong, ROC.
Bone Marrow Transplant. 2002 Mar;29(6):509-13. doi: 10.1038/sj.bmt.1703415.
Haemorrhagic cystitis (HC) is an important complication after bone marrow transplantation (BMT). Overt HC (grade > or =2, gross haematuria, clot retention and impairment of renal function), clinically more important than mild and occult HC (grade 1, microscopic haematuria), leads to substantial morbidity and occasional mortality. We retrospectively analyzed 32 cases of clinically overt HC from a series of 236 BMT patients. Significant risk factors included the use of busulphan during conditioning, allogeneic BMT and acute GVHD. Logistic regression showed GVHD to be the most important risk factor. According to the time of engraftment, HC could be divided into pre- and post-engraftment subtypes. Pre-engraftment HC was brief, not more severe than grade 2, and subsided with supportive treatment. In contrast, post-engraftment HC was protracted, often of grade > or =3, associated with severe GVHD, and required surgical intervention in many cases. Polyoma BK viruria, but not adenoviruria, could be demonstrated in both types of HC. The increased severity and association with GVHD of post-engraftment HC suggested that attack of urothelium by immunocompetent cells, possibly directed against BK viral antigens, might play a pathogenetic role.
出血性膀胱炎（HC）是骨髓移植（BMT）后的一种重要并发症。显性HC（≥2级，肉眼血尿、血凝块潴留及肾功能损害）在临床上比轻度和隐匿性HC（1级，镜下血尿）更为重要，可导致严重的发病率甚至偶尔的死亡。我们回顾性分析了236例BMT患者中32例临床显性HC的病例。显著的危险因素包括预处理期间使用白消安、异基因BMT和急性移植物抗宿主病（GVHD）。逻辑回归分析显示GVHD是最重要的危险因素。根据植入时间，HC可分为植入前和植入后亚型。植入前HC病程短暂，不超过2级，经支持治疗后可消退。相比之下，植入后HC病程迁延，常≥3级，与严重GVHD相关，且在许多情况下需要手术干预。两种类型的HC均可检测到多瘤BK病毒尿，但未检测到腺病毒尿。植入后HC严重程度增加且与GVHD相关，提示免疫活性细胞对尿路上皮的攻击（可能针对BK病毒抗原）可能起致病作用。
