本文選題：移植物抗宿主病 + HLA單倍體　； 參考：《新疆醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：分析研究親緣HLA 2-3個(gè)位點(diǎn)不合(單倍體)非體外去T細(xì)胞外周血造血干細(xì)胞移植后(RHNT-PSCT)患者慢性移植物抗宿主病(cGVHD)的臨床特征、相關(guān)危險(xiǎn)因素及其對(duì)預(yù)后的影響。方法：回顧性分析2006年1月1日至2013年6月30日我中心行RHNT-PSCT且存活超過(guò)100天的85例患者的臨床資料。分析cGVHD的發(fā)生率、分類及其主要臨床表現(xiàn),與同期行同胞HLA全相合非體外去T細(xì)胞外周血造血干細(xì)胞移植(MSNT-PSCT)的60例患者進(jìn)行比較；并分析cGVHD發(fā)生的危險(xiǎn)因素及其對(duì)患者預(yù)后的影響。結(jié)果：①單倍體組cGVHD的累積發(fā)生率與全相合組比較,差異無(wú)明顯統(tǒng)計(jì)學(xué)意義[65.9%(95%CI,55%-76.8%)比69.7%(95%Cl,57.7%-81.7%),P0.05]；而局限性和廣泛性cGVHD的累積發(fā)病率的兩組間比較,差異均有統(tǒng)計(jì)學(xué)意義[50.9%(95%C,,39.3%-62.5%)比35.3%(95%CI,24.2%-48.8%),P=0.026]；[15.6%(95%CI,7.4%-23.8%)比37.9%(95%CI,25.0%-50.8%),P=0.006]。②單倍體組常見的受累器官分布依次為皮膚(56.9%)肝臟(20.7%)口腔(17.2%)眼睛(3.4%)神經(jīng)系統(tǒng)(1.7%)；全相合組的器官受累分布為肝臟(34.5%)皮膚(29.1%)口腔(21.8%)眼睛(7.3)胃腸道(3.6%)、肌肉關(guān)節(jié)(3.6%)。③多因素分析提示急性移植物抗宿主病(aGVHD)是cGVHD及廣泛性cGVHD的唯一危險(xiǎn)因素；而HLA單倍體移植則與廣泛性cGVHD的低發(fā)病率有關(guān)。④預(yù)后分析結(jié)果顯示：cGVHD組的患者的復(fù)發(fā)率(RR)明顯低于無(wú)cGVHD組,總存活率(OS)、無(wú)病存活率(DFS)及移植相關(guān)死亡率(TRM)的差異則無(wú)統(tǒng)計(jì)學(xué)意義；而兩亞型的cGVHD的預(yù)后比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論：采用RHNT-PSCT移植模式,患者的cGVHD的發(fā)病率較MSNT-PSCT組無(wú)明顯增高,且廣泛性cGVHD發(fā)病率低,絕大多數(shù)患者為皮膚、肝臟、口腔受累,提示該移植模式可行；預(yù)防aGVHD的發(fā)生可能能夠降低嚴(yán)重cGVHD的發(fā)生率；cGVHD與降低患者RR存在一定聯(lián)系。
[Abstract]:Objective: to study the clinical characteristics, risk factors and prognosis of chronic graft-versus-host disease (HLA) in patients with HLA 2-3 loci incompatibility (haploid) after peripheral blood stem cell transplantation (PBSCT). Methods: the clinical data of 85 RHNT-PSCT patients who survived more than 100 days from January 1, 2006 to June 30, 2013 were retrospectively analyzed. The incidence, classification and main clinical manifestations of cGVHD were analyzed, and compared with 60 cases of MSNT-PSCT who underwent sibling HLA complete matched peripheral blood stem cell transplantation (PBSCT) in vitro. The risk factors of cGVHD and its influence on prognosis were analyzed. Results there was no significant difference in the cumulative incidence rate of cGVHD between the two groups. There was no significant difference in the cumulative incidence of cGVHD between the two groups [65.9and 95CI-55-76.8] compared with 69.795. The cumulative incidence rate of cGVHD was 57.7- 81.7p0.05, while the cumulative incidence of localized and extensive cGVHD was higher than that of the control group (P 0.05), but there was no significant difference between the two groups in the cumulative incidence of cGVHD. 宸紓鍧囨湁緇熻瀛︽剰涔塠50.9%(95%C,,39.3%-62.5%)姣，

本文編號(hào)：1793952