本文選題：重型地中海貧血 + 同胞異基因造血干細(xì)胞移植�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究影響重型地中海貧血患者同胞異基因造血干細(xì)胞移植(allogenic hematopoietic stem cell transplantation,allo-HSCT)后巨細(xì)胞病毒(cytomegalovirus,CMV)感染的相關(guān)危險(xiǎn)因素。方法:收集2007年7月至2017年1月在本院接受同胞異基因造血干細(xì)胞移植的重型地中海貧血患者的臨床資料,進(jìn)行回顧性分析。統(tǒng)計(jì)地貧患者allo-HSCT后CMV感染的發(fā)生率及中位發(fā)生時(shí)間。將患者性別、年齡、移植前血清鐵蛋白水平、肝臟大小、人類白細(xì)胞抗原(Human leukocyte antigen,HLA)相合、干細(xì)胞來(lái)源、預(yù)處理方案抗人胸腺細(xì)胞球蛋白(antithymocyte globulin,ATG)使用劑量、急慢性移植物抗宿主病(graft-versus-host disease,GVHD)、移植后是否合并細(xì)菌、真菌感染、移植后粒缺時(shí)間等因素納入研究,分析影響重型地貧患者allo-HSCT后CMV感染的相關(guān)危險(xiǎn)因素。結(jié)果:共納入233例病例,男160例,女73例,中位年齡4.5(1.5-19)歲。Allo-HSCT后25.8%的患者(60/233)發(fā)生CMV感染,初次感染的中位時(shí)間為移植后30(7-114)天,移植后100天內(nèi)感染發(fā)生率為98.3%(59/60)。單因素分析提示性別、干細(xì)胞來(lái)源與移植后CMV感染相關(guān)。女性組CMV感染發(fā)生率較男性組高(40.2%vs 19.5%,P=0.001,χ2=10.226);臍血+骨髓(umbilical cord blood+bone marrow,UCB+BM)組較外周血+骨髓(peripheral blood+bone marrow,PB+BM)組CMV感染發(fā)生率高(37.9%vs13.5%,P0.001,χ2=17.615)。多因素分析也提示性別、不同來(lái)源干細(xì)胞是移植后CMV感染的獨(dú)立危險(xiǎn)因素。結(jié)論:女性患者和臍帶血來(lái)源干細(xì)胞是重型地貧患者移植后發(fā)生CMV感染的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to study the risk factors of cytomegalovirus (CMV) infection after allogenic hematopoietic stem cell transplantation-HSCT in patients with severe thalassemia.Methods: the clinical data of severe thalassemia patients receiving sibling allogeneic hematopoietic stem cell transplantation from July 2007 to January 2017 were retrospectively analyzed.The incidence and median time of CMV infection after allo-HSCT in thalassemia patients were analyzed.Patients' sex, age, serum ferritin level before transplantation, liver size, human leukocyte antigen human leukocyte antigen-HLA), stem cell source, pretreatment regimen antithymocyte globulin globulinizing dose,Graft-versus-host disease of acute and chronic graft-versus-host disease (GVHD), whether the graft-versus-host disease was associated with bacteria, fungal infection, and the time of granulocytosis after transplantation were studied. The risk factors affecting CMV infection after allo-HSCT in patients with severe thalassemia were analyzed.Results: a total of 233 patients (160 males and 73 females with a median age of 4.5 1.5-19) developed CMV infection after Allo-HSCT (25.8%). The median time of initial infection was 307-114 days after transplantation. The incidence of infection within 100 days after transplantation was 98.359 / 60%.Univariate analysis showed that sex and stem cell origin were associated with CMV infection after transplantation.The incidence of CMV infection in the female group was higher than that in the male group (40.2 vs 19.5P = 0.001, 蠂 2 10.226), and the incidence of CMV infection in the umbilical cord blood cord blood bone marrowgroup was higher than that in the peripheral blood blood bone marrowPB group (P 0.001, 蠂 2 = 17.615).Multivariate analysis also suggested that different stem cells were independent risk factors for CMV infection after transplantation.Conclusion: stem cells derived from umbilical cord blood and female patients are independent risk factors for CMV infection after transplantation in severe thalassemia patients.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R556.61

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