HLA不相合与相合外周血干细胞移植后发生出血陛膀胱炎的多因素对比分析

Comparative analysis of multiple factors of hemorrhagic cystitis after HLA-mismatched and HLA- matched peripheral blood hematopoietic stem cell transplantation

目的对比分析HLA不相合与相合异基因外周血干细胞移植后出血性膀胱炎（HC）的危险因素。方法对1998年3月至2008年3月间接受HLA不相合与相合异基因外周血干细胞移植的120例患者发生HC的情况进行回顾对比分析。结果120例患者中23例发生了HC，所有HC均为迟发性，Ⅰ度8例，Ⅱ度10例，Ⅲ度4例，Ⅳ度1例，中位起病时间为移植后27（21～45）d，中位持续时间为16（7～70）d。单因素分析发现，年龄〈25岁、预处理使用抗胸腺细胞球蛋白（ATG）、HLA不相合移植为HC发病的高危因素。多因素分析发现HLA不相合移植（RR=8．266，95％C，=2．16～37．79，P=0．001）为HC发病的独立危险因素。结论HC是异基因外周血干细胞移植后常见的并发症，HLA不相合移植是其发生的独立危险因素。

Objective Comparative analysis of the risk factors of hemorrhagic cystitis （HC） after HLA-mismatched and HLA-matched allogeneic peripheral blood hematopoietic stem cell transplantation （Allo-PBSCT） were conducted. Methods The medical records of 120 patients undergoing allo-PBSCT in our hospital from March 1998 to March 2008 were analyzed. Results 23 of 120 patients occurred HC, and they were all late-onset of HC. There were HC of grade Ⅰ in 8 cases, grade Ⅱ in 10 cases, grade Ⅲ in 4 cases, grade Ⅳ in 1 case. The median time of onset was 27 days after allo-PBSCT（range 21-45 days）, the median duration of HC was 16 days （range 7-70 days）. Univariate analysis indicated that the age, younger than 25, ATG usage, HLA-mismatched transplantation were associated with the occurrence of HC, while in multiple regression analysis only HLA-mismatched transplantation（RR=8.266, 95 % CI=2.16-37.79, P =0.001） was independent risk factor. Conclusion HC after allogeneic peripheral blood stem cell transplantation is a common complication, HLA-mismatched transplantation is the independent risk factor.