异基因造血干细胞移植术对急性白血病患者甲状腺功能影响的危险因素研究

A Study of Risk Factors for the Effect of Allogeneic Hematopoietic Stem Cell Transplantation on Thyroid Function in Patients with Acute Leukemia

目的探讨急性白血病(acute leukemia,AL)患者在异基因造血干细胞移植术(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗后导致甲状腺疾病(thyroid dysfunction,TD)的患病情况及危险因素。方法收集2018年1月至2023年6月于云南省第一人民医院血液内科初次行allo-HSCT的98例AL患者的临床资料进行回顾性分析。所有AL患者均予抗肿瘤药物(除免疫检查点抑制剂)和allo-HSCT治疗,根据是否发生TD分为非TD组(n=55)和TD组(n=43),收集患者的一般情况、实验室指标资料,分析2组间的资料是否有统计学差异,并探讨接受allo-HSCT治疗引起TD的相关危险因素。结果在接受allo-HSCT治疗的98例AL患者中,43例(43.8%)发生甲状腺功能异常,其中甲状腺功能减退(包括临床甲减、亚临床甲减)22例,甲状腺功能亢进(包括临床甲亢、亚临床甲亢)9例,单纯抗体升高12例。非TD组、TD组一般情况的单因素分析中发现,移植时的年龄、性别、供体与受体关系、HLA配型、供受体血型、粒细胞植入时间、PLT植入时间无统计学意义(P>0.05),疾病类型、是否并发aGVHD差异有统计学意义(P<0.05)。二元Logistic回归分析表明移植后并发aGVHD是发生TD的危险因素(OR=3.693,95%CI=1.166~11.699,P<0.05);与基础疾病ALL对比,AML及其他AL发生甲状腺障碍的风险更高(P<0.05)。结论甲状腺功能减退是AL患者接受allo-HSCT治疗引起TD最常见的类型,移植后急性非淋系白血病发生TD概率更高,患者并发aGVHD是TD的危险因素。

Objective To investigate the incidence and identify risk factors associated with thyroid disease(TD)in patients diagnosed with acute leukemia(AL)following allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Clinical data of 98 AL patients who underwent allo-HSCT for the first time in the Department of Hematology of the First People's Hospital of Yunnan Province from January 2018 to June 2023 were collected and retrospectively analyzed.All AL patients were treated with anti-tumor drugs(excluding immune checkpoint inhibitors)and allo-HSCT,divided into non-TD group(n=55)and TD group(n=43)based on whether TD occurred.We collected the patients'general information and laboratory data,analyzed whether there were statistical differences between the two groups,and explored the related risk factors for TD after allo-HSCT treatment.Results Among the 98 AL patients who underwent allo-HSCT,43(43.8%)exhibited abnormal thyroid function,including 22 cases of hypothyroidism(comprising clinical and subclinical hypothyroidism),9 cases of hyperthyroidism(including clinical and subclinical hyperthyroidism),and 12 cases of elevated thyroid antibodies.Univariate analysis of the non-TD group and TD group showed no statistical significance in age,gender,donorrecipient relationship,HLA matching,donor and recipient blood type,neutrophil implantation time and PLT implantation time(P>0.05).However,there were statistically significant differences in disease type and the presence of concurrent aGVHD(P<0.05).The binary logistic regression analysis revealed that aGVHD was identified as a significant risk factor for the development of thyroid disorders after transplantation(OR=3.693,95%CI=1.166~11.699,P<0.05).Furthermore,when compared to the underlying disease ALL,AML and other AL exhibited a significantly higher susceptibility to thyroid disorders(P<0.05).Conclusion Hypothyroidism is the most common type of TD caused by allo-HSCT treatment in AL patients,and TD is more likely to occur in acute non-lymphocytic post-transplantation,and patients with aGVHD is a risk factor for TD.