造血干细胞移植后出血性膀胱炎的临床研究

Study on hemorrhagic cystitis in patients after hematopoietic stem cell transplantation

目的 探讨造血干细胞移植术后,出血性膀胱炎发生的相关因素、治疗措施和预后.方法 回顾性分析该科2001年6月至2010年9月385例接受造血干细胞移植术治疗患者出血性膀胱炎的发生、治疗和预后情况.结果 385例患者中有19例发生出血性膀胱炎,发病率4.9%,中位发病时间28 d（6～68 d）,中位病程26 d（19～41 d）.其中因出血性膀胱炎死亡1例,其余患者通过碱化、水化、留置尿管冲洗膀胱、抗GVHD、抗病毒等治疗后痊愈.多因素分析提示,清髓性预处理、巨细胞病毒感染是移植后出血性膀胱炎发生的相关因素.结论 出血性膀胱炎的发生与多因素相关,给予巯乙磺酸钠、还原型谷胱甘肽及碱化、水化、冲洗膀胱等措施对出血性膀胱炎有良好的防治作用.

Objective To explore the relative risk factors,therapeutic measures and prognostic estimation of hemorrhagic cystitis （HC） in patients after hematopoietic stem cell transplantation（HSCT）. Methods Information of the morbidity,therapy and prognosis of HC in 385 cases of patients,who received HSCT in our department during Jun. 2001 to Sep. 2010 were retrospectively analyzed. Results Among the 385 patients,4.9~//00（19/385） developed HC 6--68 days after HSCT and the course of disease were between 19--41 days. Except 1 patient died of HC,other 19 patients were cured by be treated with alkalinization of urine,intravenous infusion of solution containing glucose and electrolytes, urethral catheterization for rinsing bladder and anti-GVHD and anti virus therapy. Myeloablative regiment and cytomegalovirus infection were the main risk factors of HC,indicated by multiplicity analysis. Conclusion The morbidity of HC is associated with multiple factors and can be prevented and treated by mesna,glutathione,alkalinization of urine,intravenous infusion of solution containing glucose and electrolytes and rinsing bladder.