兒童異基因造血干細(xì)胞移植后并發(fā)免疫性溶血性貧血10例：?jiǎn)沃行难芯?/H1>
發(fā)布時(shí)間：2018-11-04 17:04
【摘要】：目的:總結(jié)兒童異基因HSCT后AIHA的發(fā)生率、發(fā)病機(jī)制、危險(xiǎn)相關(guān)因素、治療效果,以期為臨床提供參考。方法:回顧性分析2007年6月至2015年12月31日在重慶醫(yī)科大學(xué)附屬兒童醫(yī)院血液腫瘤中心進(jìn)行異基因HSCT后并發(fā)AIHA的患者的移植特征及臨床特點(diǎn),總結(jié)并探討AIHA的發(fā)生率;單因素分析移植相關(guān)因素(包括:疾病類型、供者類型、干細(xì)胞來源、預(yù)處理方案、GVHD預(yù)防方案、HLA相合性、ABO血型相合性、供受者性別相合性、急性GVHD分度及是否并發(fā)慢性GVHD等)與AIHA的關(guān)系;并進(jìn)一步分析AIHA的獨(dú)立危險(xiǎn)因素,探討AIHA的臨床治療效果及其與總體生存率的關(guān)系。單因素分析采用卡方檢驗(yàn),組間對(duì)比采用log-rank檢驗(yàn),多因素分析采用Cox比例風(fēng)險(xiǎn)回歸模。結(jié)果:本研究中97例行異基因HSCT的患者中10例發(fā)生AIHA,總體發(fā)生率為10.3%;1年累計(jì)發(fā)病率為5.6%;18.2%WAS患者移植后發(fā)生AIHA(8/44);41.2%合并慢性GVHD的患兒在移植后發(fā)生不同程度AIHA(7/17)。AIHA的中位發(fā)生時(shí)間為D+93天;WAS患者組移植后AIHA的累積發(fā)生率顯著高于血液系統(tǒng)惡性疾病患者組(P=0.043);供受者ABO血型次側(cè)不合移植組患者移植后AIHA的累積發(fā)生率高于血型相合移植組患者(P=0.044);而供受者血型主側(cè)不合組患者移植后早期AIHA的累積發(fā)生率與血型相合移植組患者或次側(cè)不合移植組患者相比,差異無統(tǒng)計(jì)學(xué)意義。10例患者AIHA的發(fā)生均在免疫功能完全重建之前;除2例患者在造血重建前即發(fā)生AIHA外,其余8例患者AIHA的發(fā)生均在造血基本重建以后;合并慢性GVHD是移植后并發(fā)AIHA的獨(dú)立危險(xiǎn)因素;30%移植后AIHA為難治性AIHA,利妥昔單抗對(duì)難治性AIHA可能有效。結(jié)論:兒童異基因HSCT后AIHA的發(fā)生率相對(duì)較高,尤其是WAS患者;無關(guān)供者移植后AIHA發(fā)生率較MSD患者高,合并慢性GVHD是并發(fā)AIHA的獨(dú)立危險(xiǎn)因素;AIHA的發(fā)生可能與HSCT后受者體內(nèi)的免疫失調(diào)程度相關(guān);利妥昔單抗可能對(duì)難治性AIHA有效。目前仍需要大樣本研究對(duì)AIHA的發(fā)生率、危險(xiǎn)因素、發(fā)生機(jī)制及有效治療措施進(jìn)行更全面的分析。
[Abstract]:Objective: to summarize the incidence, pathogenesis, risk factors and therapeutic effect of AIHA after allogeneic HSCT in children. Methods: the transplant characteristics and clinical characteristics of patients with AIHA after allogeneic HSCT were analyzed retrospectively from June 2007 to December 31 2015 in the Children's Hospital affiliated to Chongqing Medical University. The incidence of AIHA was summarized and discussed. Univariate analysis of transplant related factors (including disease type, donor type, stem cell source, preconditioning protocol, GVHD prophylaxis, HLA compatibility, ABO blood type compatibility, donor gender compatibility, The relationship between acute GVHD grading and chronic GVHD, etc.) and AIHA; Furthermore, the independent risk factors of AIHA were analyzed, and the clinical effect of AIHA and its relationship with overall survival rate were discussed. Chi-square test was used for single factor analysis, log-rank test was used for inter-group contrast, and Cox proportional risk regression model was used for multivariate analysis. Results: in this study, the overall incidence of AIHA, was 10.3 in 97 patients with allogeneic HSCT, the cumulative incidence in one year was 5.6 / 18.2was and the incidence of AIHA was 8 / 44 (8 / 44). 41.2% of the children with chronic GVHD had different degrees of AIHA after transplantation (the median time of 7 / 17). AIHA was D 93 days), the cumulative incidence of AIHA in the WAS group was significantly higher than that in the hematological malignancy group (P0.043). The cumulative incidence of AIHA in the donor group with ABO blood group subtransplantation was higher than that in the matched donor group (P0. 044). The cumulative incidence of early AIHA in donor blood group was higher than that in blood matching group or subtransplantation group. There was no significant difference. The occurrence of AIHA in 10 patients was before the complete reconstruction of immune function. With the exception of 2 patients who developed AIHA before hematopoietic reconstitution, 8 patients with AIHA occurred after basic hematopoietic reconstitution, and chronic GVHD was the independent risk factor of AIHA after transplantation. After transplantation, 30% of the patients with AIHA were resistant to AIHA, and Rituximab might be effective in the treatment of refractory AIHA. Conclusion: the incidence of AIHA after allogeneic HSCT is higher in children, especially in WAS patients, the incidence of AIHA in unrelated donors is higher than that in MSD patients, and chronic GVHD is an independent risk factor for AIHA. The occurrence of AIHA may be related to the degree of immune disorder in recipients after HSCT, and Rituximab may be effective for refractory AIHA. There is still a need for a more comprehensive analysis of the incidence, risk factors, pathogenesis and effective treatment of AIHA.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R725.5
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1 王丹;自身免疫性溶血性貧血52例臨床分析[J];新醫(yī)學(xué);1990年05期
2 胡繼征;AIHA的血清學(xué)特性及交叉配血1例[J];中國(guó)生物制品學(xué)雜志;2005年06期
3 陳興長(zhǎng),郭瑞官;自身免疫性溶血性貧血24例[J];實(shí)用兒科臨床雜志;1993年S1期
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3 徐衛(wèi);繆扣榮;洪鳴;范磊;吳雨潔;喬純;李建勇;;直接抗球蛋白試驗(yàn)在慢性淋巴細(xì)胞白血病預(yù)后判斷中的意義研究[A];第12屆全國(guó)實(shí)驗(yàn)血液學(xué)會(huì)議論文摘要[C];2009年
4 陳永玲;鄧明鳳;王長(zhǎng)征;;46例AIHA患者實(shí)驗(yàn)室指標(biāo)的分析[A];第四屆全國(guó)臨床檢驗(yàn)學(xué)術(shù)會(huì)議論文匯編[C];2006年
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本文編號(hào)：2310550
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[Abstract]:Objective: to summarize the incidence, pathogenesis, risk factors and therapeutic effect of AIHA after allogeneic HSCT in children. Methods: the transplant characteristics and clinical characteristics of patients with AIHA after allogeneic HSCT were analyzed retrospectively from June 2007 to December 31 2015 in the Children's Hospital affiliated to Chongqing Medical University. The incidence of AIHA was summarized and discussed. Univariate analysis of transplant related factors (including disease type, donor type, stem cell source, preconditioning protocol, GVHD prophylaxis, HLA compatibility, ABO blood type compatibility, donor gender compatibility, The relationship between acute GVHD grading and chronic GVHD, etc.) and AIHA; Furthermore, the independent risk factors of AIHA were analyzed, and the clinical effect of AIHA and its relationship with overall survival rate were discussed. Chi-square test was used for single factor analysis, log-rank test was used for inter-group contrast, and Cox proportional risk regression model was used for multivariate analysis. Results: in this study, the overall incidence of AIHA, was 10.3 in 97 patients with allogeneic HSCT, the cumulative incidence in one year was 5.6 / 18.2was and the incidence of AIHA was 8 / 44 (8 / 44). 41.2% of the children with chronic GVHD had different degrees of AIHA after transplantation (the median time of 7 / 17). AIHA was D 93 days), the cumulative incidence of AIHA in the WAS group was significantly higher than that in the hematological malignancy group (P0.043). The cumulative incidence of AIHA in the donor group with ABO blood group subtransplantation was higher than that in the matched donor group (P0. 044). The cumulative incidence of early AIHA in donor blood group was higher than that in blood matching group or subtransplantation group. There was no significant difference. The occurrence of AIHA in 10 patients was before the complete reconstruction of immune function. With the exception of 2 patients who developed AIHA before hematopoietic reconstitution, 8 patients with AIHA occurred after basic hematopoietic reconstitution, and chronic GVHD was the independent risk factor of AIHA after transplantation. After transplantation, 30% of the patients with AIHA were resistant to AIHA, and Rituximab might be effective in the treatment of refractory AIHA. Conclusion: the incidence of AIHA after allogeneic HSCT is higher in children, especially in WAS patients, the incidence of AIHA in unrelated donors is higher than that in MSD patients, and chronic GVHD is an independent risk factor for AIHA. The occurrence of AIHA may be related to the degree of immune disorder in recipients after HSCT, and Rituximab may be effective for refractory AIHA. There is still a need for a more comprehensive analysis of the incidence, risk factors, pathogenesis and effective treatment of AIHA.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R725.5
【相似文獻(xiàn)】
相關(guān)期刊論文 前10條
1 王丹;自身免疫性溶血性貧血52例臨床分析[J];新醫(yī)學(xué);1990年05期
2 胡繼征;AIHA的血清學(xué)特性及交叉配血1例[J];中國(guó)生物制品學(xué)雜志;2005年06期
3 陳興長(zhǎng),郭瑞官;自身免疫性溶血性貧血24例[J];實(shí)用兒科臨床雜志;1993年S1期
4 鐘彩霞;氯喹放散法解決AIHA患者疑難配血1例[J];臨床輸血與檢驗(yàn);2000年04期
5 李文益;;自身免疫性溶血性貧血研究進(jìn)展[J];中華婦幼臨床醫(yī)學(xué)雜志;2008年03期
6 陸榮;周雪麗;李強(qiáng);李鵬;李琳;李彤彤;閻石;;AIHA特異性抗-D輸血分析及文獻(xiàn)復(fù)習(xí)[J];臨床血液學(xué)雜志(輸血與檢驗(yàn)版);2013年05期
7 李正良,高心慰;自身免疫性溶血性貧血治療進(jìn)展[J];綜合臨床醫(yī)學(xué);1998年04期
8 李曉征;白玉盛;;15例AIHA配血過程中相關(guān)問題及其對(duì)策[J];檢驗(yàn)醫(yī)學(xué)與臨床;2007年08期
9 Shiro Miwa ,杜傳書;自身免疫性溶血性貧血[J];廣東醫(yī)學(xué);1984年10期
10 楊偉民;孫鳳;;自身免疫性溶血性貧血治療進(jìn)展[J];醫(yī)學(xué)研究雜志;2007年10期
相關(guān)會(huì)議論文 前10條
1 劉丹;李茹;賈園;蘇茵;;自身免疫性溶血性貧血為首發(fā)表現(xiàn)的顯微鏡下多血管炎的臨床研究[A];第17次全國(guó)風(fēng)濕病學(xué)學(xué)術(shù)會(huì)議論文集[C];2012年
2 莊蕓;徐衛(wèi);沈云峰;李建勇;;慢性淋巴增殖性疾病合并自身免疫溶血性貧血15例研究[A];第13屆全國(guó)實(shí)驗(yàn)血液學(xué)會(huì)議論文摘要[C];2011年
3 徐衛(wèi);繆扣榮;洪鳴;范磊;吳雨潔;喬純;李建勇;;直接抗球蛋白試驗(yàn)在慢性淋巴細(xì)胞白血病預(yù)后判斷中的意義研究[A];第12屆全國(guó)實(shí)驗(yàn)血液學(xué)會(huì)議論文摘要[C];2009年
4 陳永玲;鄧明鳳;王長(zhǎng)征;;46例AIHA患者實(shí)驗(yàn)室指標(biāo)的分析[A];第四屆全國(guó)臨床檢驗(yàn)學(xué)術(shù)會(huì)議論文匯編[C];2006年
5 羅澤民;蔡艷;葉飄;劉艷梅;卞則棟;黃勇;;小兒自身免疫性溶血性貧血17例臨床分析[A];中華醫(yī)學(xué)會(huì)第十四次全國(guó)兒科學(xué)術(shù)會(huì)議論文匯編[C];2006年
6 吳慧明;李國(guó)民;汪海寧;胡文靜;余忠杰;陳清;沈雪慧;喬敏;;“AIHA”、“毛擴(kuò)癥”伴腫瘤患者臨床輸血1例[A];中國(guó)輸血協(xié)會(huì)第三屆輸血大會(huì)論文專輯[C];2004年
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9 張魯芳;張琳;朱尊民;楊靖;郭建民;張茵;;環(huán)孢菌素A綜合免疫抑制方案治療難治性AIHA和Evans綜合征[A];第十一屆全國(guó)紅細(xì)胞疾病學(xué)術(shù)會(huì)議暨學(xué)習(xí)班論文匯編[C];2007年
10 宋小川;哈麗代;;輸注洗滌紅細(xì)胞治療自身免疫性溶血性貧血[A];中國(guó)輸血1999年年會(huì)暨紀(jì)念A(yù)BO血型發(fā)現(xiàn)100周年學(xué)術(shù)交流論文專輯[C];1999年
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