摘要
目的总结儿童造血干细胞移植(HSCT)后中枢神经系统(CNS)并发症的种类、发生时间、有无移植物抗宿主病(GVHD)、感染等情况,并分析CNS并发症发生特点及诸多因素与CNS并发症之间的关系。方法回顾性分析408例行HSCT治疗患儿发生CNS并发症的危险因素、特点及预后等。结果408例患儿移植后发生CNS并发症者共35例(8.58%)。主要CNS并发症包括可逆性后部脑病综合征(PRES)、颅内感染、中毒性脑病、高血压脑病、免疫性脑炎、移植后淋巴增殖性疾病等。Ⅲ-Ⅳ度GVHD、氟达拉滨、抗胸腺细胞球蛋白、吗替麦考酚酯(MMF)、他克莫司(FK506)、移植前后感染是影响异基因HSCT后CNS并发症发生的相关临床因素,进一步分析提示Ⅲ-Ⅳ度GVHD、使用包含MMF和FK506的GVHD防治方案为HSCT后CNS并发症特别是PRES发生的危险因素。结论有效预防和治疗GVHD、选择合适的GVHD防治方案对减少HSCT后CNS并发症的发生至关重要,在今后工作中需更加关注免疫抑制药物应用与其产生CNS并发症之间的利弊关系。
Objective By investigate the types,occurrence time of CNS complications,and their relationship with graft-versus-host disease and infections,etc.after hematopoietic stem cell transplantation,the characteristics of CNS complications and their relationship among many factors were analyzed.Methods Retrospectively analyzed the situation of 408 children treated with HSCT,and the risk factors,characteristics and prognosis of central nervous system complications were studied.Results Among the 408 children,35 cases(8.58%)developed CNS complications after transplantation.Major CNS complications include reversible posterior encephalopathy syndrome(PRES),intracranial infection,toxic encephalopathy,hypertensive encephalopathy,Immunological encephalitis,and post-transplant lymphoproliferative disorders,et al.Ⅲ°-Ⅳ°graft versus host disease(GVHD),fludarabine,antithymocyteglobulin,mycophenolatemofetil(MMF),FK506,and infection before and after transplantation were associated with the occurrence of CNS complications after allogeneic HSCT.Further analysis showed thatⅢ-Ⅳ°GVHD and the use of regimens containing MMF and FK506 were risk factors for CNS complications,especially PRES,after HSCT.Conclusions Effective prevention and treatment of GVHD are important to reduce the occurrence of CNS complications after HSCT,and more attention should be paid to the pros and cons between the application of immunosuppressive drugs and their CNS complications in the future.
作者
江一志
张璐颖
孟岩
雷小英
于洁
窦颖
JIANG Yizhi;ZHANG Luying;MENG Yan;LEI Xiaoying;YU Jie;DOU Ying(Department of Hematology Oncology Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Child Infection and Immunity,Chongqing 400014,China)
出处
《中国小儿血液与肿瘤杂志》
CAS
2023年第6期362-368,380,共8页
Journal of China Pediatric Blood and Cancer
基金
重庆医科大学未来医学青年创新团队发展支持计划(W0132)
重庆市科卫联合项目(2021MSXM112)。
关键词
儿童
造血干细胞移植
中枢神经系统
并发症
Child
Hematopoietic stem cell transplantation
Central nervous system
Complication
