异基因造血干细胞移植后并发癫痫病因分析

Analysis of the etiology of epilepsy after allogeneic hematopoietic stem cell transplantation

目的:探讨异基因造血干细胞移植(Allo-HSCT)后癫痫并发症的病因、临床特点及高危因素。方法:回顾性分析148例Allo-HSCT患者癫痫发生情况及特点,并分析其病因及高危因素。结果:148例患者中,Allo-HSCT后1年内10例发生癫痫,发生率为6.8%,病死率高达60%(6/10)。癫痫发生的病因有药物、颅内出血、颅内感染、内环境紊乱和移植相关性血栓性微血管病(TMA)。癫痫发生率在HLA全相合与不全相合的患者中分别为3.2%(3/94)和13.0%(7/54)(P<0.05),在并发急性移植物抗宿主病(aGVHD)>Ⅱ度和≤Ⅱ度的患者中分别为21.1%(4/19)和4.7%(6/129)(P<0.05),在伴有或不伴高血压患者中分别为33.3%(7/21)和2.4%(3/127)(P<0.01)。结论:药物、颅内出血、颅内感染、内环境紊乱和TMA是Allo-HSCT后癫痫发生的常见病因,HLA不全相合、aGVHD和高血压是癫痫发生的高危因素。

Objective： To investigate the etiology, clinical features and risk factors of epilepsy after allogeneic hematopoietic stem cell transplantation （AIlo-HSCT）. Method：We observed the occurrence and clinical features of epilepsy in patients who underwent Allo-HSCT and analyzed its causes and risk factors. Result： Ten cases of 148 patients developed epilepsy within one year after Allo-HSCT, with an incidence of 6.8 % and a mortality of 60 %. The etiology of epilepsy included drugs,intracranial hemorrhage,intracranial infection,internal environment disor- ders and transplant associated thrombotic microangiopathy （TMA）. The incidence of epilepsy in HLA identical ca- ses and HLA mismatched cases was 3.2% （3/94） and 13.0% （7/54） （P^0.05） ,and in patients with acute graft- versus host disease （aGVHD） above grade ]I and less than or equals grade II was 21.1% （4/19） and 4.7% （6/ 129） （P〈0. 05） ,and in patients with hypertension and without hypertension was 33.3% （7/21） and 2.4% （3/ 127 ） （P〈0.01 ）. Conclusion ： Drugs, intracranial hemorrhage, intracranial infection, internal environment disorders and TMA are the common causes of epilepsy after Allo-HSCT. HLA mismatched, aGVHD and hypertension are risk factors of epilepsy.