Luo Xiao-Dan, Liu Qi-Fa, Ning Juan, Fan Zhi-Ping, Xu Dan, Wei Yong-Qiang
Department of Hematology, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515, China.
Zhonghua Nei Ke Za Zhi. 2008 Jan;47(1):40-3.
To investigate the morbidity, clinical manifestations, and imageology characteristics, and the influencing factors of severe cyclosporine A (CsA)-related neurotoxicity (SNCT) in the patients after allogenic hematopoietic stem cell transplantation (allo-HSCT).
Finding of SNCT was carried out in 164 allo-HSCT recipients from January 2003 to June 2006. Clinical characteristics were analysed, including precursory symptoms and clinical manifestations. Associations between the onset of SNCT with blood CsA levels, age, transplant types, human leucocyte antigen (HLA) matching, conditioning regimens, antihuman thymocyte globulin (ATG) used in the prevention and treatment for graft-versus-host disease (GVHD) and intravenous corticosteroid used for acute GVHD were analyzed. Statistical analysis was performed with Binary Logistic Regression using SPSS/PC version 11.0.
Thirteen patients (7.93%) were identified to have SNCT, including seizures (n = 8, 4.88%), paralysis (n = 6, 3.66%), coma (n = 2, 1.22%), cerebellar ataxia (n = 3, 1.83%) and chondroid encephalomyopathy (n = 1, 0.61%). All the patients had precursory symptoms prior SNCT including headache (n = 8), agitation (n = 4) and hypertension (n = 6). Magnetic resonance imaging (MRI) performed in twelve patients after SNCT showed that eleven patients had signal abnormalities in cerebral cortex and cerebral white matter. Six patients examined with computerized tomography (CT) had no abnormal findings. After extenuation or withdrawal of CsA, ten patients had complete recovery, two had partial recovery and one died of SNCT. Simple effect analysis of Binary Logistic Regression showed that the associations between the onset of SNCT with blood CsA levels, transplant types, HLA matching, ATG used in the prevention and treatment for GVHD and intravenous corticosteroid used for acute GVHD were of statistical significance. The multiple effect analysis of Binary Logistic Regression showed that the associations of the onset of SNCT with blood CsA levels and ATG used had statistical significance and the odds ratio (OR) was 1.007 (P = 0.006) and 6.727 (P = 0.030), respectively.
91.67% of the allo-HSCT recipients with SNCT have MRI abnormalities. High blood CsA levels and the use of ATG can elevate the risk of the occurrence of SNCT.
探讨异基因造血干细胞移植（allo-HSCT）后患者中严重环孢素A（CsA）相关神经毒性（SNCT）的发病率、临床表现、影像学特征及影响因素。
对2003年1月至2006年6月期间164例allo-HSCT受者进行SNCT的筛查。分析临床特征，包括前驱症状和临床表现。分析SNCT的发病与血CsA水平、年龄、移植类型、人类白细胞抗原（HLA）配型、预处理方案、用于预防和治疗移植物抗宿主病（GVHD）的抗人胸腺细胞球蛋白（ATG）以及用于急性GVHD的静脉用糖皮质激素之间的相关性。使用SPSS/PC 11.0版软件通过二元Logistic回归进行统计学分析。
13例患者（7.93%）被确诊为SNCT，包括癫痫发作（n = 8，4.88%）、瘫痪（n = 6，3.66%）、昏迷（n = 2，1.22%）、小脑共济失调（n = 3，1.83%）和软骨样脑脊髓病（n = 1，0.61%）。所有患者在发生SNCT之前均有前驱症状，包括头痛（n = 8）、烦躁（n = 4）和高血压（n = 6）。12例SNCT患者进行的磁共振成像（MRI）检查显示，11例患者大脑皮质和脑白质有信号异常。6例接受计算机断层扫描（CT）检查的患者未发现异常。在减量或停用CsA后，10例患者完全恢复，2例部分恢复，1例死于SNCT。二元Logistic回归的单因素分析显示，SNCT的发病与血CsA水平、移植类型、HLA配型、用于预防和治疗GVHD的ATG以及用于急性GVHD的静脉用糖皮质激素之间的相关性具有统计学意义。二元Logistic回归的多因素分析显示，SNCT的发病与血CsA水平和使用ATG之间的相关性具有统计学意义，比值比（OR）分别为1.007（P = 0.006）和6.727（P = 0.030）。
91.67%的发生SNCT的allo-HSCT受者有MRI异常。高血CsA水平和使用ATG可增加SNCT发生的风险。
