异基因造血干细胞移植患者肌肉质量与急性移植物抗宿主病相关性的研究

Relationship between Muscle Mass of Limbs and aGVHD in Patients with Allogeneic Hematopoietic Stem Cell Transplantation

目的:探讨肌肉质量与急性移植物抗宿主病(aGVHD)的相关性。方法:回顾性分析广州市第一人民医院血液内科144例行异基因造血干细胞移植患者的临床资料,收集患者的年龄、性别、诊断、供者年龄、供者性别、预处理方案、ATG剂量、HLA配型、移植物来源、输注干细胞数量等资料,同时采用生物电阻抗原理测定患者移植前和移植后3个月的四肢肌肉量、体重、体质量指数、腰臀比、上臂肌围、三头肌皮褶厚度、体脂率等,比较患者移植前后的四肢肌肉量变化及其与aGVHD的相关性。结果:61.11%的患者出现肌肉质量减少,男女占比分别为35.42%、25.69%。与移植前相比,移植后患者的体重、体质量指数、上臂肌围和四肢肌肉量均有所下降(均P<0.05)。比较低肌肉量组和正常肌肉量组患者aGVHD的累积发生率,发现低肌肉质量患者Ⅱ-Ⅳ度aGVHD累积发生率(30.38%)高于正常肌肉量组(8.93%),差异有统计学意义(P<0.05)。单因素分析结果显示:肌肉质量、供者性别、预处理方案是aGVHD的影响因素(P<0.05)。二分类Logistic回归发现低肌肉质量为影响患者aGVHD的独立危险因素(P<0.05)。结论:异基因造血干细胞移植患者移植后普遍存在肌肉质量下降,且肌肉量下降的患者aGVHD的发生率更高。因此,开展早期造血干细胞移植患者的肌肉质量评估,有利于尽早地发现患者aGVHD的发生。

Objective: To explore the correlation of limb muscle mass and acute graft-versus-host disease. Methods:Clinical data from 144 patients treated by allo-HSCT in Guangzhou First People′s Hospital were collected and analyzed retrospectively. The age, sex, diagnosis, donor age, sex of the donors, preparative regimen, ATG dose, HLA match, graft source, and number of infused stem cells of the patients were collected as baseline information. Meanwhile, bioelectrical impedance principle(BIA) was used to measure the limb muscle mass, body weight, body mass index(BMI), waist-tohip ratio, upper arm muscle circumference, triceps skinfold thickness, and body fat rate of the patients before and after transplantation, so as to compare the changes of limb muscle mass and investigate its correlation with aGVHD. Results:It was found that 61.11% of allo-HSCT patients showed muscle mass loss, and the proportion of male and female was35.42% and 25.69%, respectively. There were reduction in the body weight, BMI, upper arm muscle circumference and muscle mass of limbs after transplantation as compared with those before transplantation(P<0.05). By comparing with the cumulative incidence of aGVHD between the patients in low muscle mass group and normal muscle mass group, it was found that the cumulative incidence of Ⅱ-Ⅳ degree aGVHD in patients with low muscle mass(30.38%) was higher than those with normal muscle mass(8.93%), which showed statistical difference(P<0.05). Univariate analysis showed that muscle mass, the sex of the donors, and preparative regimen were the influencing factors of aGVHD(P<0.05). Binary logistic regression showed that low muscle mass was the independent risk factor affecting aGVHD(P<0.05). Conclusion:Patients treated by allo-HSCT shows a decline in muscle mass after transplantation, and the incidence of aGVHD is high in patients with low muscle mass. Therefore, the assessment of muscle quality in early stage in patients with HSCT can facilitate earlier detection of aGVHD.