造血干细胞移植后早期出血并发症的危险因素与预后分析

Risk factors and prognosis of bleeding complications after hematopoietic stem cell transplantation

目的了解造血干细胞移植(HSCT)患者早期出血并发症的状况,分析其危险因素及与生存的关系。方法观察318例HSCT患者的出血状况,按出血程度分为轻、中、重度出血,按出血部位分为皮肤黏膜、消化道、呼吸道、女性阴道、眼、颅内出血及出血性膀胱炎(HC),选用Logistic回归模型分析各因素与出血的相关性,Cox比例风险模型进行预后分析。结果 211例患者在移植后初期发生出血并发症,其中轻度143例(45.0%),中度59例(18.6%),重度9例(2.8%)。预处理方案含ATG(OR=3.460)、异基因来源干细胞(OR=1.918)、感染(OR=1.691)、急性移植物抗宿主病(aGVHD)(OR=2.252)、血小板最低值≤15×109/L(OR=2.499)是出血的危险因素,异基因移植(OR=5.431)、aGVHD(OR=5.059)、巨细胞病毒感染(OR=4.241)、多瘤病毒尿(OR=5.723)是HC的危险因素,重度出血(RR=6.106)、出血部位位于颅内(RR=12.131)及呼吸道(RR=9.202)可独立增加移植后死亡风险。结论移植期间血小板减少等多种因素可造成出血风险增加,重度出血、颅内出血及呼吸道出血增加移植后患者死亡风险。

Objective To study the bleeding complications in patients following hematopoietic stem cell transplantation （HSCT）, then to analyze the risk factors and survival in the patients with bleeding. Methods Observing the bleeding situation in 318 patients, bleeding severity was divided into mild, mod- erate or severe cases. According to the sites, bleeding was divided into the skin and mucous membranes, gastrointestinal, respiratory, vagina, eye, intracranial bleeding and hemorrhagic cystitis （HC）. Logistic regression model was selected to analyze the association between risk factors and bleeding. Cox propor- tional hazards model was also used for the prognostic analysis. Results Two hundred and eleven patients developing bleeding complications in the early stage after HSCT including 143 mild cases （45.0%）, 59 moderate cases （ 18.6% ） and 9 severe cases （2.8%）. Pretreatment regimen factors such as ATG （ OR = 3. 460）, allogeneic source of stem cells （ OR = 1. 918 ）, infection （ OR = 1. 691 ）, acute graft-versus- host disease （aGVHD） （OR =2.252） and platelet minimum value≤15×109/L （OR = 2.499） werethe risk factors for bleeding after HSCT. Allogeneic transplant （OR =5. 431 ）, aGVHD （OR = 5. 059 ）, cytomegalovirus infection （ OR = 4. 241 ） and polyomavirus in urine （ OR = 5. 723 ） were risk factors for HC. Severe bleeding （RR =6. 106）, bleeding sites located in the intracranial （RR = 12. 131 ） and re- spiratory （RR = 9. 202） systems independently increased the mortality after HSCT. Conclusion Va- rious factors such as thrombocytopenia during HSCT can increase the risk of bleeding. Severe bleeding, intracranial hemorrhage and respiratory tract bleeding can increase the mortality after transplantation.