异基因造血干细胞移植后的相关并发症及危险因素

Complications and risk factors after allogeneic hematopoietic stem cell transplantation

背景:有效预防和治疗异基因造血干细胞移植后并发症是提高患者存活率的重要因素。目的:分析异基因造血干细胞移植后相关并发症的发生和危险因素。方法:应用文献检索的方法获取异基因造血干细胞移植后相关并发症研究的文献,对符合研究标准的文献进行深入的数据分析,文章选取异基因造血干细胞移植后极易发生的并发症进行分析,如肺部并发症、真菌性败血症、巨细胞病毒感染以及中枢神经系统并发症等。结果与结论:异基因造血干细胞移植后易出现肺部并发症,而且死亡率较高,肺部并发症的发病机制可能与移植物抗宿主病和巨细胞病毒抗原血症相关。异基因造血干细胞移植后真菌性败血症病原菌以假丝酵母菌属为主,死亡率较高,应二级预防性和早期经验性抗真菌治疗。更昔洛韦、膦甲酸钠对异基因造血干细胞移植后巨细胞病毒感染的治疗有效。中枢神经系统并发症在异基因造血干细胞移植后发生率较低,但在治疗过程也不容忽视。异基因造血干细胞移植后相关并发症的发生与多种危险因素有关,在临床治疗过程中要对相关因素采取预防措施,减少并发症的发生,提高患者的存活率。

BACKGROUND： Effective prevention and treatment of complications after aUogeneic hematopoietic stem cell transplantation is an important factor to improve patient survival. OBJECTIVE： To analyze complications and risk factors after allogeneic hematopoietic stem cell transplantation. METHODS： Based on literature search, relevant articles concerning complications a^er allogeneic hematopoietic stem cell transplantation were retrieved and analyzed. Here, we analyzed common complications after allogeneic hematopoietic stem cell transplantation, such as pulmonary complications, fungal sepsis, cytomegalovirus infections, and central nervous system complications. RESULTS AND CONCLUSION： Pulmonary complications with a higher mortality are commonly seen after allogeneic hematopoietic stem cell transplantation. The pathogenesis of pulmonary complications may be associated with graft-versus-host disease and cytomegalovirus antigenemia. The main pathogen of fungal sepsis after allogeneic hematopoietic stem cell transplantation is Candida, also with a higher mortality. Therefore, second preventive and early empirical antifungal therapy should be performed. Ganciclovir and foscamet are effective in the treatment of cytomegalovirus infections after allogeneic hematopoietic stem cell transplantation.Incidence of central nervous system complications after allogeneic hematopoietic stem cell transplantation is relatively low, but the course of treatment cannot be ignored. Complications after allogeneic hematopoietic stem cell transplantation are associated with multiple risk factors. During the clinical treatment, preventive measures for relevant factors should be taken to reduce the incidence of complications and improve patient survival.