异基因造血干细胞移植后慢性移植物抗宿主病危险因素分析

Analysis of risk factors for the development of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植后慢性移植物抗宿主病(cGVHD)的发生及其危险因素。方法总结1997年11月至2005年1月治疗的96例患者临床资料,分析了受者年龄、供受者性别、疾病种类、状态、病程、干细胞来源、HLA配型、预处理方案(是否全身照射)、回输细胞数量、移植早期感染、是否发生过急性移植物抗宿主病(aGVHD)等因素与cGVHD发生的关系。结果36例患者发生了cGVHD,发生率为44.4%。发生局限型cGVHD的19例患者的5年生存率为18/19(94.7%),发生广泛型cGVHD的17例患者5年生存率为8/17(47.1%)。两者比较差别有统计学意义(P<0.01)。单因素分析显示:供受者性别、疾病种类、状态、病程,干细胞来源、预处理方案(是否全身照射)、回输细胞数量、移植早期感染均与cGVHD的发生无显著相关性(P>0.05)。多因素分析(logistic回归)确定HLA配型不合(RR=2.17,P<0.01)、发生过aGVHD(RR=2.91,P<0.01)是发生cGVHD的主要危险因素。单因素分析显示:受者年龄越大,cGVHD发病危险性越高(P<0.05)。结论HLA配型不合及发生过aGVHD、受者年龄较大是与cGVHD发生相关的危险因素。

Objective To investigate the incidence and risk factors of chronic graft-versus-host disease （cGVHD） after allogeneic haematopoietic stem cell transplantions （HSCT）. Methods The clinical data of allo-HSCT in 96 patients from November 1997 to January 2005 was analyzed. Results cGVHD was developed in 36 cases（44.4% ）. The 5-year survival rate for local cGVHD was 8/17 （47.1% ）, while that for extenstive cGVHD was 8/17 （47.1%. Tweleve possible factors correlated with the development of cGVHD was analyzed. The univariate analysis showed that donor and recipient g sex, the diagnosis , ststus or stage of disease, stem cell source, conditioning regimen （TBI/without TBI）, stem cell number and neutropenic infection were not closely associated with the occurance of cGVHD （P 〉 0.05）. On the logistic regression model, 2 independent factors for cGVHD were identified. HLA mismatch（ RR = 2.17 ,P 〈 0.01 ） and occurred aGVHD （ RR = 2.91, P 〈 0.01 ）. In addition, the univariate analysis showed the cGVHD was strongly associated with the older patients （ P 〈 0.05 ）. Conclusion cGVHD is a common complication after HSCT, HLA mismatch, occurred aGVHD and recipient＇s older age are independent risk factors for cGVHD.