摘要
背景:在造血干细胞采集过程中需以复方枸橼酸钠抗凝全血,枸橼酸盐可鳌合血液中的钙离子,形成不能离子化的枸橼酸钙而引起血液中钙离子下降,引起低钙血症。目的:探寻在外周血干细胞采集期间预防及治疗低钙血症的最佳方法。设计、时间及地点:析因设计的观察对比实验,于1998-10/2007-12在华中科技大学附属协和医院血液科完成。对象:共纳入168例外周血造血干细胞采集患者,其中健康异基因外周血造血干细胞供者122例,自体外周血造血干细胞移植46例。方法:采集前皮下注射粒细胞集落刺激因子进行干细胞动员,至第5天应用Cobe Spectra血细胞分离机的自动外周血干细胞采集程序进行外周血造血干细胞采集,平均循环血量为8410mL,分离过程中平均采血速度为42mL/min。163例供者采集2次,5例采集3次,共341次。根据补钙方案分为2组,口服组102例供者(共209例次采集)口服葡萄糖酸钙;静脉组66例(共132例次采集)静脉持续滴注葡萄糖酸钙。主要观察指标:采集期间观察两组供者低钙血症相关症状的发生,采集完毕后从产品袋中留取标本计算有核细胞数和CD34+细胞计数。结果:①口服组209例次的供者采集中,43例次(20.6%)出现如口周、四肢麻木感、胃肠道反应、胸闷、头昏等的低钙血症表现,经加大口服葡萄糖酸钙剂量或静脉注射100g/L葡萄糖酸钙症状均得到控制;静脉组132例次的供者采集中,5例次(3.8%)出现低钙血症表现,经加大静脉注射100g/L葡萄糖酸钙症状亦得到控制。口服组供者低钙血症的发生率显著高于静脉组(P<0.01)。②口服组和静脉组采集物中的有核细胞数、CD34+细胞计数差异无显著性意义(P>0.05)。结论:应用血细胞分离机采集外周血造血干细胞时,采用静脉持续滴注葡萄糖酸钙补钙的方法明显优于口服葡萄糖酸钙,且不影响造血干细胞的采集效率。
BACKGROUND： Acid citrate dextrose-A （ACD-A） which is used as decoagulant in peripheral blood stem cells （PBSC） harvesting will combine calcium ion in blood to form calcium citrate which cannot be ionized and lead to hypocalcemia. OBJECTIVE： To explore the best way for prophylaxis and treatment of hypocalcemia during PBSC harvesting. DESIGN, TIME AND SETTING： Observation and comparison. The experiment was performed at Department of Hematology, Union Hospital of Huazhong University of Science and Technology between November 1998 and December 2007. PARTICIPANTS： 168 patients undergoing PBSC harvesting were enrolled. 122 of them were allogenic HLA-matched healthy donors, and 46 were harvested for auto-PBSC. METHODS： All of the 168 donors were given subcutaneous injection of granulocyte colony-stimulating factor （G-CSF） for stem cell mobilization. On day five, peripheral blood stem cells were collected by Cobe Spectra blood cells separator with auto-peripheral blood stem cell program. The mean circulation volume was 8 410 mL and the mean inlet rate was 42 mL/min. 163 donors underwent collection twice, and the other 5 underwent three times, so 341 collections were done. To prevent hypocalcemia, all donors.were divided into two groups： 10% calcium gluconate was given orally to 102 donors （oral group, 209 collections）, and intravenously in 66 cases （intravenous group, 132 collections） during collection. MAIN OUTCOME MEASURES： Hypocalcemia associated symptoms were observed during collection. Nucleated cell and CD34 positive cell counting in samples from collection bag was performed. RESULTS： Adverse effects including anesthesia of limbs and lips, gastrointestinal tract reactions, chest distress and dizziness, et al occurred in 43 cases （20.6%） of the oral group donors and were cured by oral or intravenous 100 g/L calcium gluconate additionally, while occurred in 5 cases （3.8%） of the intravenious group and were cured by intravenous 100 g/L calcium gluconate additionally. Hypocalcemia incidence in oral group was significantly higher than in intravenious group （P 〈 0.01）. No differences were found between oral and intravenous groups in terms of mean number of nucleated cells and CD34^＋ cells （P 〉 0.05）. CONCLUSION： Incidence of hypocalcemia is lower while calcium gluconate is given intravenously during PBSC harvesting than oral calcium gluconate, while the efficiency of harvesting is not affected.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第47期9327-9330,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
