造血干细胞移植术后以截瘫为主要表现的神经系统合并症

Neurological Complications with Paraplegia as Main Manifestation after Hematopoietic Stem Cell Transplantation

目的:探讨造血干细胞移植术后出现以截瘫为主要表现的神经系统合并症的病因、诊断和治疗方法。方法:总结自2014年1月至2017年1月在我院血液科接受造血干细胞移植治疗后出现以截瘫为主要表现的神经系统合并症9例的临床特点,诊疗经过以及预后随访。结果:截瘫的发病率为2.96%(9/304),中位发病时间为移植后245(50-772)d,完善检查后确定截瘫病因,3例为白血病髓外复发累及脊髓,1例为环孢素神经毒性,1例为格林-巴利综合征(GBS),2例为慢性炎症脱髓鞘性多神经病(CIDP),2例为自身免疫性脊髓病变。除1例患者放弃治疗外,其余8例患者均接受经验性或针对性治疗,中位随访时间为11个月,死亡5例,存活4例。结论:截瘫是HSCT术后严重的并发症,应尽早明确病因后针对性治疗,必要时可予以经验性抢先治疗,以改善HSCT患者的生存率及生活质量。

Objective:To investigate the cause,diagnosis and therapeutic method of the neurological complication with the main manifestation of paraplegia after the hematopoietic stem cell transplantation(HSCT).Methods:The clinical features,the process of diagnosis and treatment and the prognosis follow-up of 9 cases,who received HSCT in our department during January 2014 and January 2017 and had the neurological complication with the main symptom of paraplegia after the transplantation,were summarized.Results:The incidence rate of paraplegia was 2.96%(9/304).The median onset time was 245 days(50 days-772 days)after transplantation.The cause of paraplegia determined by examination was extramedullary recurrence of leukemia in 3 cases,cyclosporin neurotoxicity in 1 case,GBS in1 case,CIDP in 2 cases and autoimmune myeleterosis in 2 cases.One patient abandoned the treatment.The rest 8 patients received empirical or targeted treatment.The median follow-up period was 11 months.There were 5 dead cases and 4 survival cases.Conclusion:Paraplegia is a serious post-HSCT complication.The cause of paraplegia should be determined as early as possible to perform targeted treatment.Empirical preemptive treatment should be given if necessary,so as to improve the survival rate and the quality of life of HSCT patients.