慢性移植物抗宿主病的临床特征及其对预后的影响

发布时间：2018-04-23 22:32

  本文选题：移植物抗宿主病 + HLA单倍体　； 参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：分析研究亲缘HLA 2-3个位点不合(单倍体)非体外去T细胞外周血造血干细胞移植后(RHNT-PSCT)患者慢性移植物抗宿主病(cGVHD)的临床特征、相关危险因素及其对预后的影响。方法：回顾性分析2006年1月1日至2013年6月30日我中心行RHNT-PSCT且存活超过100天的85例患者的临床资料。分析cGVHD的发生率、分类及其主要临床表现,与同期行同胞HLA全相合非体外去T细胞外周血造血干细胞移植(MSNT-PSCT)的60例患者进行比较；并分析cGVHD发生的危险因素及其对患者预后的影响。结果：①单倍体组cGVHD的累积发生率与全相合组比较,差异无明显统计学意义[65.9%(95%CI,55%-76.8%)比69.7%(95%Cl,57.7%-81.7%),P0.05]；而局限性和广泛性cGVHD的累积发病率的两组间比较,差异均有统计学意义[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单倍体组常见的受累器官分布依次为皮肤(56.9%)肝脏(20.7%)口腔(17.2%)眼睛(3.4%)神经系统(1.7%)；全相合组的器官受累分布为肝脏(34.5%)皮肤(29.1%)口腔(21.8%)眼睛(7.3)胃肠道(3.6%)、肌肉关节(3.6%)。③多因素分析提示急性移植物抗宿主病(aGVHD)是cGVHD及广泛性cGVHD的唯一危险因素；而HLA单倍体移植则与广泛性cGVHD的低发病率有关。④预后分析结果显示：cGVHD组的患者的复发率(RR)明显低于无cGVHD组,总存活率(OS)、无病存活率(DFS)及移植相关死亡率(TRM)的差异则无统计学意义；而两亚型的cGVHD的预后比较,差异均无统计学意义。结论：采用RHNT-PSCT移植模式,患者的cGVHD的发病率较MSNT-PSCT组无明显增高,且广泛性cGVHD发病率低,绝大多数患者为皮肤、肝脏、口腔受累,提示该移植模式可行；预防aGVHD的发生可能能够降低严重cGVHD的发生率；cGVHD与降低患者RR存在一定联系。
[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�寮傚潎鏈夌粺璁″�︽剰涔塠50.9%(95%C,,39.3%-62.5%)姣，

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