摘要
目的 探讨异基因造血干细胞移植（allo-HSCT）患者移植前和预处理期间肝功能异常的特征及其与肝脏合并症和预后的关系.方法 回顾性分析196例allo-HSCT治疗血液系统疾病患者,采集其移植前和预处理期间肝功能数据,观察其对造血重建、移植相关肝脏并发症、生存和移植相关死亡的影响.结果 196例患者中,38例移植前存在肝功能异常,159例预处理期间发生肝功能异常,28例（17.6％）出现3度肝损害,无4度肝损害出现.移植前和预处理期间肝功能异常对造血重建时间、肝静脉阻塞病（HVOD）、肝脏急性移植物抗宿主病（aGVHD）和慢性移植物抗宿主病（cGVHD）发生无显著影响.单因素分析显示年龄（P =0.022）、移植前疾病状态高危（P =0.003）、移植前AST（P=0.019）和TBil水平升高（P =0.015）、Ⅲ～Ⅳ度肝脏aGVHD（P=0.000）和HVOD（P=0.000）是影响总生存（OS）率的危险因素.多因素Cox回归分析显示移植前疾病状态为高危（P=0.002）、Ⅲ～Ⅳ度肝脏aGVHD（P=0.000）是影响OS率的独立危险因素,同时也是影响移植相关死亡（TRM）率的独立危险因素（P值分别为0.002和0.000）,而移植前和预处理期间肝功能异常对OS率和TRM率无显著影响.结论 1～2度肝功能异常患者,在密切监测肝功能、充分保肝治疗及积极预防HVOD基础上,可考虑进行allo-HSCT.
Objective To investigate the characteristics of liver dysfunction pre-transplant and during conditioning period and its impacts on transplantation related hepatic complication,overall survival （OS） and transplant-related mortality （TRM）.Methods A total of 196 patients undergoing allogeneic hematopoietic stem cell transplantation （allo-HSCT） at Peking University First Hospital were analyzed retrospectively.Liver function test for each patient was examined pre-transplant and during the period of conditioning.The correlation of liver dysfunction with hepatic complications,OS and TRM rates were analyzed.Results Liver dysfunction before transplantation was found in 38 （19.8%,38/192） patients,while damage of liver function during conditioning was found in 159 （81.1%） patients,28 of whom developed grade 3 hepatic dysfunction.There was no life-threatening impairment of liver function.No matter pre-transplant or during conditioning,liver dysfunction did not suggest apparent influence on the engraftment of neutrophil or platelet or the incidence of hepatic complications including hepatic veno occlusive disease （HVOD）,acute graft versus host disease （aGVHD） and chronic graft versus host disease （cGVHD）.Univariate analysis revealed that factors affecting OS rate included age （P =0.022）,high risk stage （P =0.003）,AST and TBil elevation before transplantation （P =0.019 and 0.015 respectively）,Ⅲ-Ⅳ hepatic aGVHD （P =0.000） and HVOD（P =0.000）.Multivariate Cox regression analysis revealed that high risk stage （P =0.002） and Ⅲ-Ⅳ hepatic aGVHD （P =0.000） were independent prognostic risk factors affecting both OS rate and TRM rate,while liver dysfunction before transplantation or during conditioning period had no apparent influence on OS rate or TRM rate.Conclusion Allo-HSCT would be administrated for the patients with mild impairment of liver function grade 1 and 2.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2014年第2期99-103,共5页
Chinese Journal of Internal Medicine
基金
卫生行业科研专项基金（20120217）
关键词
造血干细胞移植
异基因
肝功能异常
肝脏合并症
总生存
移植相关死亡
Hematopoietic stem cell transplantation, allogeneic
Liver dysfunction
Hepaticcomplication
Overall survival
Transplant-related mortality
