重型地中海贫血患者同胞造血干细胞移植后移植物抗宿主病相关危险因素分析
发布时间：2018-08-26 12:01
【摘要】：目的研究影响重型地中海贫血患者同胞造血干细胞移植后移植物抗宿主病(GVHD)的相关危险因素。方法回顾分析237例在广西医科大学第一附属医院接受同胞异基因造血干细胞移植(Allo-HSCT)的重型地中海贫血患者的临床资料,采用单因素分析及多因素分析方法分析影响地贫患者移植术后GVHD的危险因素。纳入的因素包括:患者性别、患者年龄、肝脏大小、血清铁蛋白水平、预处理方案中抗人胸腺细胞球蛋白(ATG)的使用、供者性别、供者年龄、女供男的移植方式、人白细胞抗原(HLA)相合程度、血型相合程度、移植方式和回输总有核细胞数。结果237例患者中30例(12.65%)出现GVHD。27例(11.3%)出现a GVHD。其中,18例(7.6%)为Ⅱ-Ⅳ级a GVHD。9例(3.8%)患者出现慢性移植物抗宿主病(c GVHD)。单因素分析显示患者年龄、供者年龄、HLA相合程度、移植物来源为影响Ⅱ-Ⅳ级a GVHD的危险因素。多因素分析显示供者年龄、HLA相合程度和移植物来源为Ⅱ-Ⅳ级a GVHD的独立危险因素。HLA不全相合组的Ⅱ-Ⅳ级a GVHD累积发生率(40.0%)显著高于HLA相合组的Ⅱ-Ⅳ级a GVHD累积发生率(6.9%)(P=0.003)。外周血联合骨髓组的Ⅱ-Ⅳ级a GVHD累积发生率(14.9%)显著高于脐带血联合骨髓组的Ⅱ-Ⅳ级a GVHD累积发生率(0.8%)(P0.001)。供者年龄≥10岁组的Ⅱ-Ⅳ级a GVHD累积发生率(25.0%)显著高于供者年龄10岁组(4.0%)(P0.001)。单因素分析显示供者年龄、患者移植前肝脏大小和ATG使用剂量为影响c GVHD的危险因素。多因素分析显示供者年龄和ATG的使用剂量是c GVHD的独立危险因素。供者年龄≥10岁组的c GVHD发生率(13.9%)显著高于供者年龄10岁组的c GVHD累积发生率(2.0%)(P0.001)。ATG 10mg组的c GVHD累积发生率(2.0%)显著低于ATG 8mg的c GVHD累积发生率(14.7%)(P0.001)。结论HLA相合程度、移植物来源和供者年龄是影响Ⅱ-Ⅳ级a GVHD发生率的独立危险因素。ATG的使用剂量、供者年龄为c GVHD的独立危险因素。
[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，
本文编号：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，
本文编号：2204809
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