摘要
目的探讨异基因外周造血干细胞移植(allo-HSCT)患者骨髓空窗期血小板输注影响因素及其相关性。方法利用自主开发的临床用血管理与评价信息系统检索并搜集到2014年1月-2016年12月在本院血液内科诊断为allo-HSCT的153例病例,根据病例纳入的排除标准纳入其中90例病例资料为回顾性分析对象,以allo-HSCT患者骨髓空窗期平均血小板输注量作为阈值分为输注血小板≥6个治疗量的观察组38例和输注血小板<6个冶疗量的对照组52例,比较2组骨髓空窗期血小板输注量、预处理前患者Hb、ANC、Plt、SF、血小板植活时间、植入的单个核细胞数等临床观察指标,并作Logistic回归分析。结果 1)2组间性别、年龄、原发病、供受者HLA配型、预处理前Hb、植入的单个核细胞数均较为相近(P>0.05);预处理前ANC(×10~9/L)为1.24±0.57 vs 3.36±1.33、Plt(×10~9/L)为43.55±68.29 vs 1 26.62±84.73、SF(μg/L)为2 351.05±1 587.96 vs 1 000.96±362.97、供受者ABO血型配型不合(例)为15 vs 10、血小板植活时间(d)为16.84±2.47 vs 12.73±1.65、骨髓空窗期血小板输注量(治疗量)为8.37±1.50 vs 3.63±1.12(P<0.05)。2)Logistic单因素回归分析:预处理前ANC、Plt、SF、供受者ABO血型配型、血小板植活时间,2组存在明显差异(P<0.05),为allo-HSCT骨髓空窗期血小板输注的影响因素;多因素回归分析:预处理前ANC、PLT植活时间2组存在明显差异(P<0.05)。结论预处理前ANC和血小板植活时间是allo-HSCT患者骨髓空窗期血小板输注的独立影响因素。其中血小板植活时间为独立危险因素,其越长预示血小板输注需求量越大;预处理前ANC为独立保护因素,其越大预示血小板输注量则越小。
Objective To analyze the influence of different factors and their relating correlation results on platelet transfusion during the bone marrow empty window period on the pa- tients who have undergone allogeneic peripheral blood stem cell transplantation （allo-HSCT） with retrospective analysis of case-control data. Methods Clinical data of 153 cases were collected by the clinical blood management and evaluation infor- mation system with discharge diagnosis of allo-HSCT in the hematology department of The First Affiliated Hospital of Nan- chang University within a time frame from January 2014 to December 2016. A total of 90 cases were considered valid for ret- rospective analysis according to the case exclusion criteria. The average transfusion dose for patients with allo-HSCT during the bone marrow empty window period was defined as the threshold value which divided the 90 cases into the observation group of 38 cases receiving more than 6 Units of platelet transfusion and the control group of 52 cases with less than 6Units of platelet transfusion. The amount of platelets transfused during the bone marrow empty window period, clinical indexes include Hb, ANC, Pit, SF before pretreatment, platelet engraftment time and the number of mononuclear cells implanted were com- pared and analyzed by Logistic regression.Results （1） There was no significant difference between the two groups in gen- der, age, primary diagnosis, HLA matching, Hb before pretreatment and the number of mononuclear cells implanted （P〉 0. 05）. The ANC（ x 109/L） （ 1.24±0. 57 vs 3.36±1.33） and Plt（ × 109/L） （43.55±68. 29 vs 126. 62±84. 73） counts before pretreatment in the observation group were significantly lower than those in the control group （P〈 0.05 ）. SF （μg/L） （2 351.05 ±1 587.96 vs 1 000.96± 362. 97）before pretreatment and PLT recovery time （d） （ 16. 84 ± 2.47 vs 12.73 ± 1.65 ）was significantly higher than that in the control group（P〈0. 05）. Donor-recipient ABO blood group typing incompatibility （ 15 vs 10） was significantly higher than the control group （P〈 0. 05） ; （2） Single factor Logistic regression analysis showed that ABO blood group matching, clinical indexes include ANC, Plt, SF before pretreatment, PLT recovery time were statistically significant, Only ANC before pretreatment and PLT recovery time had significant effect on the platelet transfusion during bone marrow empty window period in patients with allo-HSCT in multivariate Logistic regression analysis（ P〈0. 05）. Conclusion The ANC before pretreatment and PLT recovery time are independent factors for platelet transfusion of the bone marrow empty window period in patients with allo-HSCT. The PLT recovery time is an independent risk factor, which indicates that the longer the duration of PLT implantation, the greater the amount of platelet transfusion will be needed. Besides, the ANC before pretreatment is the independent protective factor, which indicates that the greater the ANC, the smaller the amount of platelet transfusion is required.
出处
《中国输血杂志》
北大核心
2017年第7期733-736,共4页
Chinese Journal of Blood Transfusion
基金
江西省科技重大项目(20144BBG70001)
关键词
血小板
骨髓空窗期
造血干细胞
异基因外周血
移植
platelet
bone marrow window period
hematopoietic stem cell
allogeneic peripheral blood
transplantation
