School of Kinesiology, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Biol Blood Marrow Transplant. 2019 Jan;25(1):151-156. doi: 10.1016/j.bbmt.2018.08.005. Epub 2018 Aug 10.
This study examined the effects of hematopoietic cell transplantation (HCT) and associated preparative regimens on vascular structure and function. Measures of carotid artery stiffness and brachial artery endothelial-dependent dilation were obtained in patients who had survived ≥ 2 years after HCT for hematologic malignancy and were diagnosed at ≤21 years. HCT survivors (n = 108) were examined: 66 received total body irradiation (TBI) alone or with a low-dose cranial radiation boost (TBI±LD-CRT), 19 received TBI plus high-dose cranial radiation (TBI+HD-CRT), and 23 received a chemotherapy-only preparative regimen (CHEMO). Siblings (n = 83) were invited to participate as control subjects. Although endothelial-dependent dilation did not differ between siblings and HCT survivors, carotid cross-sectional compliance, cross-sectional distensibility, diameter compliance, and diameter distensibility were greater in siblings than HCT survivors. Comparing the HCT preparative regimens, carotid cross-sectional compliance, cross-sectional distensibility, diameter compliance, diameter distensibility, and incremental elastic modulus were significantly lower in the TBI+HD-CRT group compared with siblings or with TBI±LD-CRT and CHEMO treatment groups. Cross-sectional distensibility and diameter compliance were significantly lower in the TBI±LD-CRT group compared with siblings. TBI±LD-CRT and CHEMO groups did not differ from each other in these vascular measures. HCT preparative regimens containing TBI+HD-CRT resulted in greater arterial decrements, indicating increased risk for cardiovascular disease.
本研究旨在探讨造血细胞移植（HCT）及其相关预处理方案对血管结构和功能的影响。在血液恶性肿瘤患者接受 HCT 治疗后≥2 年且≤21 岁时，对其进行颈动脉僵硬度和肱动脉内皮依赖性扩张的测量。共纳入 108 例 HCT 幸存者进行检查：66 例接受单纯全身照射（TBI）或低剂量颅脑照射（TBI±LD-CRT），19 例接受 TBI 联合高剂量颅脑照射（TBI+HD-CRT），23 例接受单纯化疗预处理方案（CHEMO）。同时邀请 83 名同胞作为对照参与研究。尽管内皮依赖性扩张在同胞和 HCT 幸存者之间没有差异，但同胞的颈动脉横截面积顺应性、横截面积可扩张性、直径顺应性和直径可扩张性均大于 HCT 幸存者。比较 HCT 预处理方案，TBI+HD-CRT 组的颈动脉横截面积顺应性、横截面积可扩张性、直径顺应性、直径可扩张性和弹性模量增量均显著低于同胞或 TBI±LD-CRT 和 CHEMO 治疗组。与同胞相比，TBI±LD-CRT 组的横截面积可扩张性和直径顺应性显著降低。TBI±LD-CRT 和 CHEMO 组在这些血管指标上无差异。含有 TBI+HD-CRT 的 HCT 预处理方案导致动脉功能下降更大，表明心血管疾病风险增加。
