摘要
目的探讨异基因造血干细胞移植(alloHSCT)后急性移植物抗宿主病(aGVHD)的发生及其危险因素。方法总结2001年11月至2004年1月在我院治疗的150例患者151次alloHSCT的临床资料。分析了受者年龄,供受者性别,供受者性别异同,供受者血型异同,患者移植前巨细胞病毒(CMV)、乙型肝炎病毒、丙型肝炎病毒血清学检测,疾病种类、状态、病程,干细胞来源,HLA配型,预处理方案[含全身照射(TBI)或不含TBI],GVHD预防方案[含抗胸腺细胞球蛋白(ATG)或不含ATG],回输CD34+细胞、CD3+细胞数量,早期植活(≤14天或>14天)及移植早期感染(除外CMV感染)等因素与aGVHD发生的关系。结果60例患者发生Ⅰ~Ⅳ度aGVHD,累积发生率40.2%,发生时间为第1天至第85天,中位时间为第21天,其中43例发生Ⅰ~Ⅱ度aGVHD,17例发生Ⅲ~Ⅳ度aGVHD。完全缓解率为63.6%。发生Ⅰ~Ⅱ度aGVHD的患者早期生存率>90%,发生Ⅲ~Ⅳ度aGVHD的患者早期生存率为46%,两者比较差异有统计学意义(P<0.01)。单因素分析显示受者年龄,供受者性别,供受者性别差异,供受者血型差异,疾病诊断,疾病状态,疾病病程,预处理方案(含TBI或不含TBI),移植物来源,回输CD34+细胞、CD3+细胞数量,早期植入以及移植早期感染均与aGVHD的发生无显著相关性(P>0.05)。多因素分析(Coxregression)确定HLA配型?
Objective To investigate the incidence and risk factors of acute graft-versus-host disease(aGVHD) after allogeneic hematopoietic stem cell transplantation(HSCT).Methods The clinical data of 151 cases of allo-HSCT in 150 patients from Nov 2001 to Jan 2004 was analyzed.Results aGVHD was deve-loped in 60 cases(40.2%),including 43 cases with grade Ⅰ～Ⅱ and 17 with grade Ⅲ～Ⅳ aGVHD, the mean time of aGVHD development was 21 days(range 1～85 days) after allo-HSCT, 35 out of 55 cases ~achieved complete response(CR)(63.6%).The early survival rate for gradeⅠ～Ⅱ aGVHD was more than 90%,while that for grade Ⅲ～Ⅳ aGVHD was 46%. Nineteen factors possibly correlated with the development of aGVHD were analyzed. The univariate analysis showed that recipient age,donor’s sex,recipient’s sex,sex and ABO blood group disparity between donor and recipient, diagnosis,the status of disease,the stage of disease,stem cell source,conditioning regimen(TBI/without TBI), CD34^+ cell number, CD3^+ cell number,early engraftment and neutropenic infection were not closely associated with the occurance of aGVHD^(P>0.05) . On the Cox regression model, 2 independent factors for grade Ⅰ～Ⅳ aGVHD were identified:HLA mismatch(RR=1.681,P<0.05) and positive surface antigen(HBsAg) (RR=1.907,P<0.05).In addition, the univariate analysis showed aGVHD was strongly associated with CMV infection(P<0.01). Conclusion aGVHD is a common complication after HSCT,HLA mismatch and HBsAg positivity are independent risk factors for aGVHD.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2005年第2期74-77,共4页
Chinese Journal of Hematology
