摘要
背景：出血性膀胱炎是造血干细胞移植后常见并发症之一。粒细胞-巨噬细胞集落刺激因子除影响造血干/祖细胞的增殖和分化外,还能调节炎性反应中单核细胞、粒细胞、淋巴细胞以及内皮细胞的功能。目的：探讨膀胱内灌注粒细胞-巨噬细胞集落刺激因子对造血干细胞移植后出血性膀胱炎的预防作用。设计：病例分析。对象：中山大学附属中山医院2004-01/2006-08接受异基因造血干细胞移植的血液病患者15例作为常规治疗组,2006-09/2008-12接受异基因造血干细胞移植的血液病患者16例作为粒细胞-巨噬细胞集落刺激因子组。方法：常规治疗组采用常规方法即美司钠、水化、碱化尿液预防出血性膀胱炎,粒细胞-巨噬细胞集落刺激因子组在其基础上,在应用环磷酰胺前24h开始向膀胱内灌注粒细胞-巨噬细胞集落刺激因子,至环磷酰胺停用3d后拔除导尿管,用生理盐水冲洗膀胱后排空膀胱,然后向300μg粒细胞-巨噬细胞集落刺激因子中加入生理盐水10mL、利多卡因5mL注入膀胱,保留60-120min。主要观察指标：出血性膀胱炎的发生及其与移植物抗宿主病的相关性,巨细胞病毒感染及泌尿系统感染的发生情况。结果：与常规治疗组比较,粒细胞-巨噬细胞集落刺激因子组出血性膀胱炎发生率明显降低（χ2=4.39,P〈0.05）,出血性膀胱炎平均持续时间、患者平均住院时间均明显缩短（t=3.97,P〈0.05;t=3.13,P〈0.05）,Ⅲ度以上出血性膀胱炎发生率明显降低（χ2=5.04,P〈0.05）。出血性膀胱炎严重程度与移植物抗宿主病严重程度、持续时间有关（r=0.76）。与常规治疗组比较,粒细胞-巨噬细胞集落刺激因子组巨细胞病毒感染率略微下降但无明显差异（χ2=0.28,P〉0.05）,巨细胞病毒感染阳性患者Ⅲ度以上出血性膀胱炎发生率升高。与常规治疗组比较,粒细胞-巨噬细胞集落刺激因子组泌尿系统感�
BACKGROUND： Hemorrhagic cystitis remains a common complication of hematopoietic stem cell transplantation. Granulocyte-macmphage colony stimulating factor （GM-CSF） affects proliferation and differentiation of hematopoietic stem/progenitor cells, adjusts functions of monocytes, granulocytes, lymphocytes and endothelial cells. OBJECTIVE： To investigate the protective effects of GM-CSF bladder irrigation in hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. DESIGN： Case analysis. PARTICIPANTS： A total of 15 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation at the Zhongshan Hospital of Sun Yat-sen University from January 2004 to August 2006 （routine treatment group）. A total of 16 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation from September 2006 to December 2008 （GM-CSF group）. METHODS： In the routine treatment group, patients received mesna, hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis. In the GM-CSF group, GM-CSF was infused into the bladder in addition to mesna, hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis 24 hours before cyclophosphamide treatment. Catheter was extracted 3 days following cyclophosphamide withdraw. Following washing with saline, the bladder was emptied. 10 mL of saline and 5 mL of lidocaine were added into 300 pg of GM-CSF. The mixture was infused into the bladder for 60 120 minutes. MAIN OUTCOME MEASURES： The following parameters were measured： occurrence of hemorrhagic cystitis and its correlation to graft versus host disease, as well as the occurrence of cytomegalovirus infection and urinary system infection. RESULTS： Compared with routine treatment group, the occurrence rate of hemorrhagic cystitis was significantly decreased in the GM-CSF group （ x2=4.39, P 〈 0.05）, mean duration of hemorrhagic cystitis and duration of hospitalization were significantly shortened （t=3.97, P 〈 0.05
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第27期5229-5233,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
中山市科技计划项目(2006C024)~~
