Jung You Jin, Jeon Yeon Jin, Cho Won Kyoung, Lee Jae Wook, Chung Nack-Gyun, Jung Min Ho, Cho Bin, Suh Byung-Kyu
Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea.
Korean J Pediatr. 2013 Jul;56(7):298-303. doi: 10.3345/kjp.2013.56.7.298. Epub 2013 Jul 19.
The purpose of this study was to evaluate short-term thyroid dysfunction and related risk factors in pediatric patients who underwent hematopoietic stem cell transplantation (HSCT) during childhood.
We studied 166 patients (100 boys and 66 girls) who underwent HSCT at the Catholic HSCT Center from January 2004 through December 2009. The mean age at HSCT was 10.0±4.8 years. Thyroid function of the patients was tested before and during 3 months of HSCT.
Out of 166 patients, 165 (99.4%) underwent allotransplantation. Acute graft-versus-host disease (GVHD, grades II to IV) developed in 76 patients. Conditioning regimens before HSCT include total body irradiation (n=57), busulfan (n=80), and reduced intensity (n=29). Forty-five (27.1%) had thyroid dysfunction during 3 months after HSCT (29 euthyroid sick syndrome [ESS], 6 subclinical hyperthyroidism, 4 subclinical hypothyroidism, 3 hypothyroxinemia, 2 overt hyperthyroidism, and 1 high T4 syndrome). In a univariate logistic regression analysis, age at HSCT (P=0.002) and acute GVHD (P=0.009) had statistically significant relationships with thyroid dysfunction during 3 months after HSCT. Also, in a univariate logistic regression analysis, ESS (P=0.014) showed a strong statistically significant association with mortality.
In our study 27.1% patients experienced thyroid dysfunction during 3 months after HSCT. Increase in age and acute GVHD may be risk factors for thyroid dysfunction during 3 months after HSCT. There was a significant association between ESS and mortality.
本研究旨在评估儿童期接受造血干细胞移植（HSCT）的儿科患者的短期甲状腺功能障碍及相关危险因素。
我们研究了2004年1月至2009年12月在天主教HSCT中心接受HSCT的166例患者（100例男孩和66例女孩）。HSCT时的平均年龄为10.0±4.8岁。在HSCT前及HSCT后3个月内对患者的甲状腺功能进行检测。
166例患者中，165例（99.4%）接受了同种异体移植。76例患者发生了急性移植物抗宿主病（GVHD，Ⅱ至Ⅳ级）。HSCT前的预处理方案包括全身照射（n=57）、白消安（n=80）和减低强度预处理（n=29）。45例（27.1%）患者在HSCT后3个月内出现甲状腺功能障碍（29例为正常甲状腺病态综合征[ESS]，6例为亚临床甲状腺功能亢进，4例为亚临床甲状腺功能减退，3例为低甲状腺素血症，2例为显性甲状腺功能亢进，1例为高T4综合征）。在单因素逻辑回归分析中，HSCT时的年龄（P=0.002）和急性GVHD（P=0.009）与HSCT后3个月内的甲状腺功能障碍有统计学显著关系。此外，在单因素逻辑回归分析中，ESS（P=0.014）与死亡率有很强的统计学显著关联。
在我们的研究中，27.1%的患者在HSCT后3个月内出现甲状腺功能障碍。年龄增加和急性GVHD可能是HSCT后3个月内甲状腺功能障碍的危险因素。ESS与死亡率之间存在显著关联。
