摘要
目的分析异基因造血干细胞移植后迟发性出血性膀胱炎(LOHC)的病因构成。方法对北京大学血液病研究所2004—2005年连续完成的200例异基因造血干细胞移植患者发生 LOHC的情况进行回顾性的分析。结果 200例移植患者中共有57例发生出血性膀胱炎(HC),均为迟发性。病因分析显示:31例 LOHC 患者接受抗病毒治疗临床达到完全缓解,病因归结为感染性,占54.39%;12例临床合并病毒血症,经过抗病毒治疗病毒血症消失,但膀胱炎症状无好转,病因归结为感染性合并有非感染性因素,占21.53%;另有14例临床无感染原的证据,其中5例单靠碱化利尿膀胱炎即获完全缓解,另外9例对抗感染治疗无效,病因归结为非感染性,占24.56%。对有非感染性因素的13例 HC 患者给予短程的激素冲击治疗,9例达到缓解,2例达到部分缓解,2例无效。共有4例对各种治疗无效,死亡时 HC 未缓解,死亡原因为其他移植相关并发症。结论出血性 HC 是异基因造血干细胞细胞移植后常见的并发症,临床应重视对感染和非感染病因的鉴别,针对病因的治疗可以提高疗效。
Objective To analyze the etiology and clinical features of late onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （HSCT）. Methods The medical records of 200 patients undergoing allogeneic HSCT from 2004 to 2005 were analyzed retrospectively. Results HC developed in 57 patients within 180 days after the transplantation with a cumulative incidence of 28. 8%. The etiology of 31 patients （54. 39% ） was infection, caused by infection of cytomegalovirus （CMV） or adenovirus and cured by anti-virus therapy, thus the cause of disease could be classified as infection agent. Viremia was seen in 12 patients （21.53%） with CMV and disappeared in urine after anti-virus therapy but bleeding still persisted. For these patients the cause of disease was classified as infection agent combined with non-infection factor. Evidence of infection agent could not be discovered in 14 patients （24. 56% ） and they failed to respond to anti-infection therapy. For them the cause of disease was classified as non-infection agent. 13 patients with refractory HC underwent tentative treatment with corticosteroids,9 of them achieved a complete remission, 2 of them achieved partial remission, and 2 of them remained nonresponsive. Conclusion LOHC after alIo-HSCT is a common complication and caused by multiple factors. Differentiation of the possible causes may benefit its clinical outcome.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第2期124-127,共4页
National Medical Journal of China
关键词
膀胱炎
造血干细胞移植
回顾性研究
感染
Cystitis
Hematopoietic stem cell transplantation
Retrospective studies
Infection
