异基因造血干细胞移植后肠道急性移植物抗宿主病危险因素分析

Analyses of risk factors for intestinal acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

目的探讨异基因造血干细胞移植（allo—HSCT）后肠道急性移植物抗宿主病（aGVHD）发生的危险因素。方法回顾性分析2004年1月至2012年9月进行allo—HSCT的533例（534例次）患者临床资料，应用Logistic回归分析供受者人类白细胞抗原（HLA）配型是否相合、患者年龄、供者年龄、供受者性别关系、供受者亲缘关系、干细胞来源、预处理含或不含全身放射治疗（TBI）、HLA位点等因素与不同程度肠道aGVHD的关系。结果123例（23．O％）患者发生肠道aGVHD，其中I度86例（16．1％），Ⅱ～Ⅳ度37例（6．9％）。多因素分析显示供受者HLA配型不合（OR=2．519，P=0．002）、供者年龄增大（OR=I．034，P=0．002）、女性供者男性受者（OR=1．840，P=-0．008）是发生肠道aGVHD的危险因素，HLA—B38（OR=0．256，P=0．032）是其保护因素；供受者HLA配型不合（OR=2．799，P=0．011）、供者年龄增大（0R=1．045，P=-0．012）、HLA-A1（OR=4．157，P=-0．002）、HLA．A30（OR=3．143，P=0．005）是发生Ⅱ～Ⅳ度肠道aGVHD的危险因素。结论肠道aGVHD的发生及严重程度与供受者HLA配型是否相合、供者年龄、供受者性别关系及某些HLA位点相关。

Objective To investigate the risk factors of intestinal acute graft-versus-host disease （aGVHD） after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The clinical data of 534 cases of 533 patients undergoing allo-HSCT during Jan 2004 and Sep 2012 were retrospectively analyzed. The effects of donor-recipient HLA mismatching, recipient age, donor age, donor-recipient sex combination, donor-recipient relationship, HSC source, conditioning regimen with or without total body irradiation （TBI） and HLA loci on intestinal aGVHD with different severity were analyzed by Logistic regression. Results Intestinal aGVHD occurred in 123 （23.0%） cases, with 86 （16.1%） cases of stage 1 intestinal aGVHD （16.1%）and 37 （6.9%） cases of stage 2 to 4 intestinal aGVHD. Multivariate analysis showed that donor-recipient HLA mismatching （OR=2.519, P=0.002）, increasing donor age （OR=1.034, P=0.003）, female donor for male recipient （OR=1.855, P=-0.007） were risk factors for intestinal aGVHD, HLA-B38 （OR=0.256,P=0.032） was its protective factor. Donor-recipient HLA mismatching （OR=2.799, P=0.011 ）, increasing donor age （OR=1.045,P=0.012）, HLA-A1 （OR=4.157,P=0.002）, A30 （OR=3.143, P=0.005） were risk factors for stage 2 to 4 intestinal aGVHD. Conclusions Occurrence of intestinal aGVHD and its severity are associated with donor-recipient HLA mismatching, donor age, donor-recipient sex relationships and some HLA loci.