摘要: |
目的:分析造血干细胞移植(HSCT)后神经系统(NS)并发症的临床特点,评估HSCT后患者发生NS并发症的相关危险因素,以提高HSCT后NS并发症的诊断和治疗,改善患者预后。
方法:回顾性分析2012年8月至2015年8月87例HSCT后发生NS并发症患者的临床资料。
结果:87例HSCT伴NS并发症患者中,中枢性神经系统并发症占71.3%(62/87)、外周性占28.7%(25/87)。NS并发症的原发病中,急性淋巴细胞白血病(ALL)占34.5%(30/87)、急性髓性白血病(AML)占23.0%(20/87)、慢性髓性白血病(CML)占12.6%(11/87)、其他类型白血病和淋巴瘤占9.2%(8/87)、再生障碍性贫血占13.8%(12/87)、骨髓增生异常综合征占6.9%(6/87);移植相关因素中,人类白细胞抗原(HLA)全相合19例(21.8%)、半相合53例(60.9%)、无关相合15例(17.2%),分别有16.1%、69.4%、14.5%发生中枢神经并发症,36.0%、40.0%、24.0%发生外周神经并发症(χ2=6.682,P=0.034)。NS并发症的其他相关因素中,儿童组和成人组发生率分别为 26.4%(23/87)和73.6%(64/87,P=0.435);伴有移植物抗宿主反应(GVHD)或感染患者的NS并发症的发生率分别为 69.0%(60/87)和59.8%(52/87,P<0.05)。87例中,伴中枢神经并发症者发病时间1~726(中位数49 )d,伴外周神经并发症者发病时间20~694(中位数80)d。87例患者的病死率为33.3%(29/87),其中伴中枢神经并发症者病死率占93.1%(27/29),伴外周神经并发症者病死率占6.9%(2/29,P<0.05)。
结论:HSCT后中枢性神经系统并发症较外周性发病率高,发病时间短,病死率高;HSCT后NS并发症与HLA配型、GVHD和感染有关。 |
关键词: 造血干细胞移植;神经系统并发症 危险因素 |
DOI:10.12025/j.issn.1008-6358.2016.20160604 |
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Abstract: |
Objective:Analyze the characteristics of nervous system (NS)complications after hematopoietic stem cell transplantation(HSCT) ,and evaluate risk factors in order to reduce its occurrence, provide better diagnosis and treatment and improve the prognosis of the patients.
Methods:The clinical outcomes of the patients who developed NS complications after HSCT were collected in our hospital from August 2012 to August 2015, and retrospective analysis was used.
Results:A total of 87 patients with NS complications after HSCT include central nervous system complications was 71.3% (62/87) and peripheral nerve complications was 28.7% (25/87). The types of primary disease included acute lymphoblastic leukemia (ALL) 34.5% (30/87), acute myelogenous leukemia (AML) 23.0% (20/87), chronic myelogenous leukemia (CML ) 12.6% (11/87), other types of leukemia by 9.2% (8/87), aplastic anemia 13.8% (12/87), myelodysplastic syndrome 6.9% (6/87); HLA matched 19 cases (21.8%), HLA mismatched 53 cases (60.9%), unrelated donors 15 cases (17.2%), central nervous system complication rate was 16.1%, 69.4% and 14.5%, respectively; peripheral nerve complication rate was 36.0%, 40.0% and 24.0% respectively (χ2=6.682, P=0.034). The incidences of NS complications were 26.4% (23/87) in children and 73.6% (64/87)in adults respectively,and there was no significant difference in the types of NS complications (P=0.435). The cases accompanied with GVHD or infection respectively account for 69.0% (60/87) and 59.8% (52/87), and there were significant difference in the incidences of types of NS complications (P<0.05). The onset time of 87 patients with nervous system complications or peripheral nerve complications was 1 726 days (median 49 days) and 20 694 days (median 80 days), respectively. The overall mortality rate was 33.3% (29/87), with central nervous system complications was 93.1% (27/29), with peripheral nerve complications was 6.9% (2/29, P<0.05).
Conclusions:The patients with central nervous system complications have higher incidence, higher mortality,and shorter onset time than the patients with peripheral nerve complications, and related with HLA types, GVHD and infection risk factors. |
Key words: hematopoietic stem cell transplantation nervous system complications risk factors |