重型地中海貧血患者同胞造血干細(xì)胞移植后移植物抗宿主病相關(guān)危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-08-26 12:01
【摘要】：目的研究影響重型地中海貧血患者同胞造血干細(xì)胞移植后移植物抗宿主病(GVHD)的相關(guān)危險(xiǎn)因素。方法回顧分析237例在廣西醫(yī)科大學(xué)第一附屬醫(yī)院接受同胞異基因造血干細(xì)胞移植(Allo-HSCT)的重型地中海貧血患者的臨床資料,采用單因素分析及多因素分析方法分析影響地貧患者移植術(shù)后GVHD的危險(xiǎn)因素。納入的因素包括:患者性別、患者年齡、肝臟大小、血清鐵蛋白水平、預(yù)處理方案中抗人胸腺細(xì)胞球蛋白(ATG)的使用、供者性別、供者年齡、女供男的移植方式、人白細(xì)胞抗原(HLA)相合程度、血型相合程度、移植方式和回輸總有核細(xì)胞數(shù)。結(jié)果237例患者中30例(12.65%)出現(xiàn)GVHD。27例(11.3%)出現(xiàn)a GVHD。其中,18例(7.6%)為Ⅱ-Ⅳ級(jí)a GVHD。9例(3.8%)患者出現(xiàn)慢性移植物抗宿主病(c GVHD)。單因素分析顯示患者年齡、供者年齡、HLA相合程度、移植物來(lái)源為影響Ⅱ-Ⅳ級(jí)a GVHD的危險(xiǎn)因素。多因素分析顯示供者年齡、HLA相合程度和移植物來(lái)源為Ⅱ-Ⅳ級(jí)a GVHD的獨(dú)立危險(xiǎn)因素。HLA不全相合組的Ⅱ-Ⅳ級(jí)a GVHD累積發(fā)生率(40.0%)顯著高于HLA相合組的Ⅱ-Ⅳ級(jí)a GVHD累積發(fā)生率(6.9%)(P=0.003)。外周血聯(lián)合骨髓組的Ⅱ-Ⅳ級(jí)a GVHD累積發(fā)生率(14.9%)顯著高于臍帶血聯(lián)合骨髓組的Ⅱ-Ⅳ級(jí)a GVHD累積發(fā)生率(0.8%)(P0.001)。供者年齡≥10歲組的Ⅱ-Ⅳ級(jí)a GVHD累積發(fā)生率(25.0%)顯著高于供者年齡10歲組(4.0%)(P0.001)。單因素分析顯示供者年齡、患者移植前肝臟大小和ATG使用劑量為影響c GVHD的危險(xiǎn)因素。多因素分析顯示供者年齡和ATG的使用劑量是c GVHD的獨(dú)立危險(xiǎn)因素。供者年齡≥10歲組的c GVHD發(fā)生率(13.9%)顯著高于供者年齡10歲組的c GVHD累積發(fā)生率(2.0%)(P0.001)。ATG 10mg組的c GVHD累積發(fā)生率(2.0%)顯著低于ATG 8mg的c GVHD累積發(fā)生率(14.7%)(P0.001)。結(jié)論HLA相合程度、移植物來(lái)源和供者年齡是影響Ⅱ-Ⅳ級(jí)a GVHD發(fā)生率的獨(dú)立危險(xiǎn)因素。ATG的使用劑量、供者年齡為c GVHD的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to study the risk factors related to graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) in patients with severe thalassemia. Methods the clinical data of 237 patients with severe thalassemia undergoing sibling allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in the first affiliated Hospital of Guangxi Medical University were retrospectively analyzed. Univariate analysis and multivariate analysis were used to analyze the risk factors of GVHD in patients with thalassemia after transplantation. The factors included: patient gender, patient age, liver size, serum ferritin level, use of antithymocyte globulin (ATG) in pretreatment regimen, donor gender, donor age, and transplantation of female donor male. Human leukocyte antigen (HLA) concordant degree, blood group match degree, transplant method and return transfusion always have nucleated cell number. Results GVHD.27 was found in 30 (12.65%) of 237 patients (11.3%) and a GVHD. was found in 30 cases (12.65%). Among them, 18 cases (7.6%) with grade 鈪，
本文編號(hào)：2204809
[Abstract]:Objective to study the risk factors related to graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT) in patients with severe thalassemia. Methods the clinical data of 237 patients with severe thalassemia undergoing sibling allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in the first affiliated Hospital of Guangxi Medical University were retrospectively analyzed. Univariate analysis and multivariate analysis were used to analyze the risk factors of GVHD in patients with thalassemia after transplantation. The factors included: patient gender, patient age, liver size, serum ferritin level, use of antithymocyte globulin (ATG) in pretreatment regimen, donor gender, donor age, and transplantation of female donor male. Human leukocyte antigen (HLA) concordant degree, blood group match degree, transplant method and return transfusion always have nucleated cell number. Results GVHD.27 was found in 30 (12.65%) of 237 patients (11.3%) and a GVHD. was found in 30 cases (12.65%). Among them, 18 cases (7.6%) with grade 鈪，
本文編號(hào)：2204809
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