[异基因造血干细胞移植后出血性膀胱炎发生的危险因素分析]

[Analysis of risk factors for the development of hemorrhagic cystitis post allogeneic hematopoietic stem cell transplantation].

作者信息

Zhang Hong-Yu, Huang Xiao-Jun, Xu Lan-Ping, Liu Dai-Hong, Liu Kai-Yan, Han Wei, Chen Huan, Chen Yu-Hong, Lu Dao-Pei

机构信息

Institute of Hematology, People's Hospital, Peking University, Beijing 100044, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2007 Apr;28(4):243-6.

PMID:17877201

Abstract

OBJECTIVE

To analyze the incidence and risk factors of hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT).

METHODS

The medical records of 250 patients undergoing allogeneic HSCT in Peking University Institute of Hematology from Sep. 2003 to Sep. 2005 were analyzed.

RESULTS

HC occurred in 72 of the 250 patients within 180 days after transplantation with a cumulative incidence of 28.8% (SE 0.3%). None of early-onset HC was developed in the cohort. The median time of onset was 33 days after HSCT (range 14 - 170 days) and the median duration of HC was 35 days (range 3 -186 days). There were HC of grade I - II in 51/72 cases (70.83%) and of grade III - IV in 21/72 (29.17%). Univariate analysis indicated that age younger than 25, high risk disease, CMV reactivation, ATG usage, graft from MUD or MMRD and GVHD grade IL - IV were associated with the occurrence of HC, while in multiple regression analysis only GVHD grade II - IV (RR = 2.75; 95% CI 1.63 -4.66; P < 0.01) and donor type (RR = 2.60; 95% CL 1.52 - 5.20; P < 0.01) were independent risk factors. Kaplan-Meier survival analysis indicated HC not increasing the mortality (RR = 0.67, 95% CI 0.33 - 1.36).

CONCLUSION

HC post allo-HSCT is a common complication, GVHD grade II - IV and donor type are the independent risk factors.

摘要

目的

分析异基因造血干细胞移植（HSCT）后出血性膀胱炎（HC）的发生率及危险因素。

方法

分析2003年9月至2005年9月在北京大学血液病研究所接受异基因HSCT的250例患者的病历。

结果

250例患者中有72例在移植后180天内发生HC，累积发生率为28.8%（标准误0.3%）。该队列中未发生早发性HC。发病中位时间为HSCT后33天（范围14 - 170天），HC的中位持续时间为35天（范围3 - 186天）。72例中有51例（70.83%）为Ⅰ - Ⅱ级HC，21例（29.17%）为Ⅲ - Ⅳ级HC。单因素分析表明，年龄小于25岁、高危疾病、巨细胞病毒再激活、使用抗胸腺细胞球蛋白、来自非血缘供者或单倍体相合供者的移植物以及Ⅱ - Ⅳ级移植物抗宿主病（GVHD）与HC的发生相关，而多因素回归分析显示只有Ⅱ - Ⅳ级GVHD（相对危险度RR = 2.75；95%可信区间CI 1.63 - 4.66；P < 0.01）和供者类型（RR = 2.60；95%CI 1.52 - 5.20；P < 0.01）是独立危险因素。Kaplan - Meier生存分析表明HC未增加死亡率（RR = 0.67，95%CI 0.33 - 1.36）。