异基因造血干细胞移植后胰腺相关指标异常患者的临床特点和影响因素分析

Clinical Characteristics and Influencing Factors of Patients with Abnormal Pancreatic Parameters after Allogeneic Hematopoietic Stem Cell Transplantation

目的研究分析异基因造血干细胞移植(allo-HSCT)后胰腺相关指标异常患者的临床特征和影响因素。方法选取2019年3月至2020年6月于广东省人民医院行allo-HSCT的血液肿瘤患者共54例,按照血清淀粉酶指标是否有异常升高分为异常组和正常组,回顾性分析两组性别、年龄、病因、移植前疾病状态、干细胞来源、供受者关系、HLA配型、胆结石病史、高甘油三酯血症病史、高胆固醇血症病史、预处理方案、移植物抗宿主病预防方案、环孢素A浓度水平各项指标和胰腺相关指标异常升高的关系。结果54例患者中有11例(20.4%)出现了血淀粉酶的升高,其中10例伴有血脂肪酶的升高,有3例(5.6%)确诊为急性胰腺炎。多因素分析结果显示,有高胆固醇血症病史、应用改良全身照射/环磷酰胺预处理方案为导致胰腺相关指标异常升高的独立危险因素(P<0.05)。结论allo-HSCT患者要重视高胆固醇血症病史的存在和预处理方案的使用,早期采取合理的干预措施,有助于防止急性胰腺炎的发生。

Objective To analyze the clinical characteristics and influencing factors of patients with abnormal pancreatic related indicators after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods A total of 54 patients with hematological malignancies underwent allo-HSCT in Guangdong Provincial People's Hospital from March 2019 to June 2020 were selected,and they were divided into abnormal group and normal group according to whether there was abnormal increase of serum amylase.The relationship between gender,age,etiology,disease status before transplantation,source of stem cells,donor recipient relationship,HLA matching,history of gallstone,history of hypertriglyceridemia,history of hypercholesterolemia,conditioning regimen,graft-versus-host disease prevention,cyclosporine A concentration and abnormal elevation of pancreatic related indicators were analyzed retrospectively.Results Among the 54 patients,11(20.4%)had elevated serum amylase,10 of them had elevated serum lipase,and 3(5.6%)were diagnosed as acute pancreatitis.Multivariate analysis suggested that history of hypercholesterolemia and application of modified total body irradiation/cyclophosphamide regimen were independent risk factors for abnormal elevation of pancreatic related indicators.Conclusions It is important to pay attention to the history of hypercholesterolemia and the application of conditioning regimen of patients receiving allo-HSCT,and it will be helpful to take reasonable intervention measures in the early stage to prevent the occurrence of acute pancreatitis.