HLA半相合造血干细胞移植后并发心律失常的临床分析

Clinical analysis of arrhythmias following haploidentical hematopoietic stem cell transplantation

目的探讨HLA半相合造血干细胞移植受者心律失常并发症的发生情况。方法对88例HLA半相合造血干细胞移植受者的资料进行回顾性分析。原发病为恶性疾病的78例采用阿糖胞苷＋白消安＋环磷酰胺＋兔抗人胸腺细胞球蛋白（ATG）进行预处理，有2例因供、受者年龄偏大或女性供者于移植当天和移植后第4天加用巴利昔单抗20mg／d。原发病为非恶性疾病的10例采用氟达拉滨＋环磷酰胺＋ATG进行预处理。采用环孢素A＋吗替麦考酚酯＋短程甲氨蝶呤联合方案预防移植物抗宿主病（GVHD）。结果排除高热、贫血等因素引起的窦性心动过速，88例既往无心血管病史的患者中有16例（占18．2％，16／88）发生心律失常共计22次（25．0％，22／88），其中窦性心动过速11次，窦性心动过缓1次；室上性心律失常6次；室性心律失常4次（3次为他克莫司诱发）。发生心律失常的时间中位数为移植后第66．5天，持续时间中位数为1．5d（1～11d）。结论HLA半相合造血干细胞移植受者存在一定程度的发生心律失常的风险，其发生可能与移植前化疗及预处理方案中药物的心脏毒性、受者的应激状态、水电解质紊乱以及他克莫司的作用等有关。

Objective To investigate the incidence of arrhythmic complications following haploidentical hematopoietic stem cell transplantation （HSCT）. Method A retrospective study was carried out for the clinical data from the 88 patients who underwent haploidentical HSCT. Seventyeight patients with malignant diseases had the conditioning regimen of cytarabine ＋ busulfan ＋ cyclophosphamide ＋ antithyrnocyte globulin（ATG）, and two of them had Basiliximab of 20 mg/day on the day of transplantation and the 4th day post-transplantation because of elder donor or receptor or the female donor. Ten patients with non-malignant diseases had the conditioning regimen of fludarabine ＋ cyclophosphamide ＋ ATG. Cyclosporin A ＋ mycophenolate mofetil ＋ short term methotrexate were used in the prophylaxis of graft-versus-host disease （GVHD）. Result Apart from the sinus tachycardia caused by fever or anemia, arrhythmic complications （22 cases） developed in 16 patients among the 88 patients who had no past history of cardiovascular disease （18. 18%, 16/88）, including sinus tachycardia （11 cases）, sinus bradycardia （1 case）, supraventricular arrhythmia （6 cases）, ventricular arrhythmias （4 cases, 3 of which induced by tacrolimus）. The arrhythmia complications occurred at a median of 66. 5 days post-transplant and persisted for a median of 1.5 days （range 1-11）. Conclusion Patients undergoing HSCT are at certain risk for developing arrhythmias, which may be related to the cardiac toxicity of the chemotherapy before HSCT or the conditioning regimen, the state of stress, the fluid and electrolyte disturbances as well as the administration of tacrolimus.