异基因造血干细胞移植后慢性移植物抗宿主病患者临床观察

Analysis of risk factors of chronic GVHD after allogeneic haematopoietic stem cell transplantation and nursing care of the patients

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)发生的危险因素及其护理。方法总结治疗的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、干细胞来源、HLA配型、预处理方案、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%。发生局限型的19例患者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%)。两者比较差异有统计学意义(P<0.01)。单因素分析显示:供受者性别、疾病状态、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);而受者年龄越大,cGVHD发病危险性越高。多因素分析确定HLA配型不合、发生过aGVHD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。结论HLA配型不合及发生过aGVHD、受者年龄较大是发生cGVHD的相关危险因素,护士重点做好此类患者的护理与院外指导较为重要。

Objective To investigate the risk factors of chronic graft - versus host disease （cGVHD） after allogeneic haematopeietic stem cell transplantation （HSCT） and nurse care of the patients. Methods Among the clinical data of 96 allo- HSCT patients from November 1997 to January 2005, such factors as age, gender, status or stage of disease, stem cell source, HLA matching, pretreatment regimen, stem cell transfusion quantity, neutropenic infection and acute graft - versus host disease （aGVHD） history of the recipients or donors were analyzed. Results cGVHI） occured in 36 cases with its incidence by 44.4%. The 5-year survival rates were 94.7% and 47.1% for limited cGVHD and for extensive cGVHD , respectively, and between them there was a significant difference （ P 〈 0. 01 ）. Univariate analysis showed that gender, status or stage of disease, stem cell source, pretreatment regimen, stem cell transfusion quantity and neutropenic infection had no remarkable correlation with cGVHD（ P 〉 0. 05 ） ,but elder age of the recipient increased the risk of cGVHD. Multivariate analysis indicated that HLA - incompatible transplantation and aGVHD histroy were major risk factors for cGVHD. Conclusion HLA - incompatible transplantation, aGVHD history and elder age of the recipient are related risk factors for cGVHD. Nursing care of the inpatients and related direction should be very important for them.