异基因造血干细胞移植后100d内腹泻病因分析

Etiology of diarrhea after allogeneic haemopoietic stem cell transplantation:a retrospective study

目的回顾性分析异基因造血干细胞移植(Allo-HSCT)后100d内腹泻的临床特点及病因谱。方法总结北京大学人民医院2006年9月至2007年3月125例Allo-HSCT患者移植后100d内的资料。结果76例发生移植后腹泻的患者累计发病114例次,总发生率60.8%(76/125)。病因分析显示,预处理毒性62例次(54.4%),急性移植物抗宿主病(aGVHD)32例次(28.1%),感染性腹泻15例次(13.2%),血栓性微血管病(TMA)及植入综合征各2例次,治疗相关性腹泻1例次。76例移植后腹泻治愈72例,死亡4例(5.3%)。Cox回归分析显示,HLA配型不合(R=6.643,P=0.026)及高危疾病状态(R=3.749,P=0.001)是腹泻发生的危险因素。结论腹泻是Allo-HSCT后的常见症状,其病因包括感染和非感染因素,针对病因的治疗可以改善预后。

Objective To retrospectively analyze the etiology and clinical features of diarrhea post allogeneic haemopoietic stem cell transplantation （allo-HSCT）. Methods Analysis was made of 125 allo-HSCT recipients in Pekin university people＇s hospital during Sep 2006 to Mar 2007. Results 114 episodes of diarrhea occurred in 76 patients with the morbidity of 60. 8% （ 76/125 ）. 62 epsiodes （ 54. 4% ） were caused by conditioning regimen ; 32 episodes （ 28. 1% ） were caused by intestinal acute graft-versus-host disease （aGVHD） ;15 episodes （13.2%） were caused by intestinal infection;2 episodes were caused by thrombotic mieroangiopathy （TMA） and engraftment syndrome respectively;in addition, 1 episode was caused by treatment. 72 patients with episodes of diarrhea were cured and 4 patients （5.3%） died. HLA mismatching （R = 6. 643 ,P = 0. 026 ） and patients with high risk （R = 3. 749 ,P = 0. 001 ） were determined to be risk factors for episodes of diarrhea by cox regression analysis. Conclusion Diarrhea is common symptom in allo-HSCT recipients, of which etiology includes infection and non-infection. Its clinical outcome could be improved by specific therapy.