造血干细胞移植后移植物抗宿主病的阴道并发症：一项横断面研究
Vaginal complications of graft-versus-host disease after hematopoietic stem cell transplantation: a cross-sectional study.
作者信息
Yaraghi Mansooreh, Mokhtari Tahereh, Mousavi Seyed Asadollah, Hazari Vajihe
机构信息
Department of Obstetrics and Gynecology, School of Medicine Shariati Hospital.
Department of Obstetrics and Gynecology and Female Infertility Unit.
出版信息
Ann Med Surg (Lond). 2024 May 22;86(7):3924-3928. doi: 10.1097/MS9.0000000000002131. eCollection 2024 Jul.
BACKGROUND
Stem cell transplantation is a clinical approach used to treat certain types of cancers, such as hematologic malignancies. Graft-versus-host disease (GVHD) occurs in 30-70% of cases and often diminishes the quality of life of transplant patients. This study aimed to determine the prevalence of vaginal complications of GVHD following hematopoietic stem cell transplantation.
METHODS
This study employed an analytical cross-sectional design. All patients referred to Shariati Hospital in Tehran between 2019 and 2020 who underwent hematopoietic stem cell transplantation were considered for inclusion in this study if they met the inclusion criteria. Inclusion criteria encompassed nonnot sexually active women aged 18-70 who received stem cell transplantation more than 100 days prior. Exclusion criteria comprised patients who experienced GVHD during the first 100 days posttransplantation. Additionally, individuals over 75 and patients with metastatic cancer were excluded.
RESULTS
A total of 55 patients were recruited, with ages averaging 40±9.9 years for recipients and 38.5±12.8 years for donors. Notably, 63.3 and 58.2% of patients exhibited oral and ocular symptoms, respectively. Regarding genital involvement, 49.1% experienced vaginal symptoms, while 25.5% had vulvar involvement. Among the 27 patients with vaginal involvement, two (7.4%) were categorized as mild, 17 (63%) as moderate, and eight (29.6%) as severe. Univariate analysis identified reduced vaginal discharge [odds ratio (OR=6.56)], vaginal tightness (OR=6.23), pelvic pain (OR=5.50), and vaginal involvement (OR=3.81) as significant predictors of other organ symptoms. Moreover, vaginal involvement (OR=3.68) emerged as the sole significant predictor of the cooccurrence of oral, ocular, and other organ symptoms. In the multivariate analysis, reduced vaginal discharge (OR=8.24) and vaginal tightness (OR=3.92) significantly predicted other organ symptoms (=0.009).
CONCLUSION
Reduced vaginal discharge and vaginal tightness remained significant predictors of other organ symptoms.
背景
干细胞移植是一种用于治疗某些类型癌症（如血液系统恶性肿瘤）的临床方法。移植物抗宿主病（GVHD）发生在30%-70%的病例中，常常降低移植患者的生活质量。本研究旨在确定造血干细胞移植后GVHD的阴道并发症患病率。
方法
本研究采用分析性横断面设计。2019年至2020年间转诊至德黑兰沙里亚蒂医院且接受造血干细胞移植的所有患者，若符合纳入标准则纳入本研究。纳入标准包括年龄在18-70岁之间、非性活跃且在100多天前接受干细胞移植的女性。排除标准包括移植后前100天内发生GVHD的患者。此外，75岁以上的个体和转移性癌症患者被排除。
结果
共招募了55名患者，接受者年龄平均为40±9.9岁, 供者年龄平均为38.5±12.8岁。值得注意的是，分别有63.3%和58.2%的患者出现口腔和眼部症状。关于生殖器受累情况，49.1%的患者有阴道症状，而25.5%的患者有外阴受累。在27例有阴道受累的患者中，2例（7.4%）为轻度，17例（63%）为中度，8例（29.6%）为重度。单因素分析确定阴道分泌物减少[比值比（OR=6.56）]、阴道紧缩感（OR=6.23）、盆腔疼痛（OR=5.50）和阴道受累（OR=3.81）是其他器官症状的重要预测因素。此外，阴道受累（OR=3.68）是口腔、眼部和其他器官症状同时出现的唯一重要预测因素。在多因素分析中，阴道分泌物减少（OR=8.24）和阴道紧缩感（OR=3.92）显著预测其他器官症状（P=0.009）。
结论
阴道分泌物减少和阴道紧缩感仍然是其他器官症状的重要预测因素。
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