1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan.
2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan.
Cell Transplant. 2017 Nov;26(11):1792-1797. doi: 10.1177/0963689717727285.
The objective of this study was to determine the incidence, risk factors, outcome, and clinical significance of pericardial effusion (PE). We retrospectively analyzed outcomes of 272 pediatric patients undergoing their first hematopoietic stem cell transplantation (HSCT) from 1998 to 2016. In total, 15% (3/20) and 5.9% (15/252) of autologous and allogeneic HSCT recipients, respectively, were identified with PE. However, there was no statistically significant difference in the incidence of PE between the 2 groups. The mean age at transplantation was 11.12 ± 5.41 y. Eighteen patients developed PE at 4.13 ± 4.44 mo after HSCT. PE was confirmed by echocardiogram in all patients. Three patients presented with severe PE with cardiac tamponade and required urgent pericardiocentesis. Overall survival (OS) rates for patients who developed PE were 83.3% and 38.9% at 100 d and 3 y, respectively, after HSCT. Death was not directly attributable to PE in patients who died in the first year after HSCT. Multivariable analysis identified the following variables to be associated with OS: PE (relative risk[RR]: 3.70; 95% confidence interval [95% CI]: 1.89-7.23; P < 0.001), active disease at HSCT (RR: 1.59; 95% CI: 1.02-2.49; P < 0.001), and thalassemia (RR: 0.62; 95% CI: 0.45-0.84; P < 0.001). PE is, thus, a debilitating and significant complication of pediatric HSCT. Therefore, prospective studies are required for better determination of the etiology and optimal method of PE treatment after HSCT.
本研究旨在确定心包积液（PE）的发生率、风险因素、结局和临床意义。我们回顾性分析了 1998 年至 2016 年间 272 例接受首次造血干细胞移植（HSCT）的儿科患者的结局。在自体 HSCT 受者中，有 15%（3/20）和 5.9%（15/252）分别发生 PE；在异基因 HSCT 受者中，有 15%（3/20）和 5.9%（15/252）分别发生 PE。然而，两组间 PE 的发生率无统计学差异。移植时的平均年龄为 11.12 ± 5.41 岁。18 例患者在 HSCT 后 4.13 ± 4.44 个月发生 PE。所有患者均通过超声心动图证实存在 PE。3 例患者出现严重的 PE 伴心包填塞，需要紧急心包穿刺。发生 PE 的患者在 HSCT 后 100 天和 3 年的总生存率（OS）分别为 83.3%和 38.9%。在 HSCT 后 1 年内死亡的患者中，死亡与 PE 无关。多变量分析确定以下变量与 OS 相关：PE（相对风险[RR]：3.70；95%置信区间[95%CI]：1.89-7.23；P < 0.001）、HSCT 时存在活动性疾病（RR：1.59；95%CI：1.02-2.49；P < 0.001）和地中海贫血（RR：0.62；95%CI：0.45-0.84；P < 0.001）。因此，PE 是儿科 HSCT 的一种衰弱且显著的并发症。因此，需要前瞻性研究以更好地确定 HSCT 后 PE 的病因和最佳治疗方法。
