儿童及青少年血液病患者单倍型造血干细胞移植后合并出血性膀胱炎临床分析

Clinical analysis of hemorrhagic cystitis in children and adolescents with hematological diseases posthaplo-hematopoietic stem cell transplantation

目的观察儿童及青少年血液病患者单倍型造血干细胞移植（haplo-HSCT）后出血性膀胱炎（HC）的临床特征并探讨其影响因素。方法回顾性分析2015至2016年接受haplo-HSCT的89例儿童及青少年血液病患者的临床资料。结果全部89例患者中，≤14岁62例（AL童组）、〉14-〈18岁27例（青少年组）；男56例，女33例；中位移植年龄10（1-17）岁；急性淋巴细胞白血病（ALL）44例，急性髓系白血病（AML）33例，急性混合细胞白血病（AHL）3例，骨髓增生异常综合征（MDS）9例。移植物来源均为骨髓＋外周血干细胞。全部89例患者中32例（36％）发生HC，其中迟发型3l例，早发型1例；I度6例、Ⅱ度16例、Ⅲ度8例、Ⅳ度2例；HC发病中位时间为移植后25（2-55）d，中位持续时间为19（3-95）d；所有患儿均获得治愈。儿童组HC发病率低于青少年组[27．4％（17／62）对55．6％（15／27）χ2=6．466，P〈0．05]。儿童组中〈5岁组HC发生率低于5-14岁组[0（0／12）对34％（17／50）χ2=4．043，P〈0．05]。结论HC是儿童及青少年血液病患者haplo-HSCT的常见并发症，总体预后良好，年龄是其发生的影响因素。

Objective To investigate the incidence and clinical features to probe the risk factors of hemorrhagic cystitis （HC） in children and adolescents with hematological diseases post haplo- hematopoietic stem cell transplantation （haplo-HSCT）. Methods Medical records of 62 children and 27 adolescents with hematological diseases treated with haplo-HSCT between 2015 and 2016 were analyzed. Results Of 89 cases （56 boys and 33 girls）, 44 patients were diagnosed with ALL, 33 AML, 3 AHL and 9 MDS. HC occurred in 32 of the 89 patients with an incidence of 36%, including 6 with grade I, 16 with grade l], 8 with grade lII, 2 with grade IV HC, respectively. The median time of HC onset was 25 days （range 2-55 days） after haplo-HSCT with the median duration as 19 days （range 3-95 days）, all of them were cured. The incidence of HC was lower in the group of children than that in the group of adolescents （27.4% vs 55.6%, χ2=6.466, P 〈 0.05）, and the incidence of HC was higher in the group of patients who were ≥5 years old than that in the group of patients who were 〈 5 years old （0 vs 34%, Z2=4.043, P〈 0.05）. Conclusion HC is one of common complications in children and adolescents with hematological diseases post haplo-HSCT, older age was associated with increased mortality.