儿童造血干细胞移植后中枢神经系统并发症的临床分析

Clinical analysis of central nervous system complications after hematopoietic stem cell transplantation in children

目的探讨儿童造血干细胞移植(HSCT)后中枢神经系统(CNS)并发症的发病情况、病因、临床特点、高危因素及预后,提高CNS并发症的诊断和治疗水平,改善患儿的生存质量。方法回顾性分析113例行HSCT治疗的患儿发生癫痫、高血压脑病、可逆性后部白质脑病综合征和移植相关的血栓性微血管病等HSCT后CNS并发症的诱因、发病特点及预后。结果 113例行HSCT治疗患儿中共7例(6.2%)发生了CNS并发症,其中1例死亡。7例患儿中,6例为HLA不全相合,1例患儿为HLA全相合。7例患儿在预处理时均应用ATG。结论 VHLA配型不全相合可能是HSCT后发生CNS并发症的高危因素。早期发现、早期诊断并积极治疗CNS并发症,可降低其病死率及后遗症的发生,有效改善患儿的生存质量。

Objective To investigate the clinical features,causes,incidence,high-risk factors and prognosis of central nervous system （CNS）complications after hematopoietic stem cell transplantation （HSCT）in children,and to improve the diagnosis and treatment of CNS complications,hence,to improve the quality of life of children.Methods A retrospective study was conducted to analyze the causes,clinical characteristics,and prognosis of CNS complications after HSCT in 1 13 patients,such as epilepsy,hypertensive encephalopathy,posterior reversible encephalopathy syndrome and transplantation-associated thrombotic microangiopathy.Results CNS complications occurred in 7 out of 1 13 （6.2%） patients after HSCT,and one child died of CAN complication.Among these 7 patients,6 patients were with HLA-mismatching compared to 1 with HLA-identical. All the 7 patients used ATG as the preconditioning regimen.Conclusions HLA-mismatching maybe a high-risk factor of CNS complications after HSCT.Early detection,diagnosis and active treatment of CNS complications can reduce the incidence and mortality,which can effectively improve the quality of life of children.