摘要
目的探讨造血干细胞移植（HSCT）后中枢神经系统（CNS）并发症的发生率影响因素及预后，提高CNS并发症的诊断和治疗水平，从而改善此类患者的生存。方法研究对象为自2001年5月至2007年12月在北京市道培医院行HSCT的640例患者，对其中发生CNS并发症患者的临床特点进行回顾性分析和研究。结果640例HSCT患者中共57例发生了CNS并发症，发生率为8．9％。非血缘、单倍型和同胞相合HSCT后CNS并发症的发生率分别为12．O％（10／83），13．5％（39／289）和3．4％（8／237）（P〈0．001）。预处理为全身照射（TBI）和非TBI方案的发生率分别为19．4％（7／36）和8．3％（50／604）（P=0．047）。年龄〈14岁组和年龄≥14岁组的发生率分别为15．3％（9／59）和8．3％（48／581）（P=0．072）。恶性疾病中的发病率为8．9％（56／627），非恶性疾病中的发病率为7．7％（1／13）（P=1．000）。最常见的并发症为原发病复发和颅内感染。患者总体病死率为57．9％（33／57），其中66．7％（22／33）的患者死亡原因为CNS并发症。结论单倍型和非血缘移植、TBI的预处理方案是移植后发生CNS并发症的高危因素。而年龄和原发病类型对CNS并发症的发病率无显著影响。早期诊断和积极有效地治疗CNS并发症可以降低其相关病死率，改善患者的预后。
Objective To study the incidence, risk factors and prognosis of central nervous system （CNS） complications after hematopoietic stem cell transplantation （HSCT） in order to prevent or reduce its occurrence, provide better diagnosis and treatment and improve the survival of the patients. Methods A total of 640 patients who consecutively underwent HSCT in our hospital between May 2001 and December 2007 were included. The clinical outcomes of the patients who developed CNS complications were analyzed. Results The patients received stem cells from haploidentical family members （Haplo, n = 289） , identical siblings （ IS, n = 237 ） , unrelated donors （ URD, n = 83 ） , unrelated cord blood （ n = 14）, syngeneic siblings （ n = 9 ） or autologous peripheral blood （ n = 8 ）. Fifty-seven of 640 patients （ 8.9% ） developed CNS complications. The incidences were 12. 0% , 13.5% and 3.4% in URD-HSCT, Haplo-HSCT and IS-HSCT respectively （P 〈0. 001）. The incidences of CNS complications were 19. 4% and 8. 3% in cases who received or did not receive conditioning with TBI （ P = 0. 047 ）. There was no significant difference in the incidences of CNS complications between children （ 15.3% ） and adults （8.3 % ） （P = 0. 072）. Similar incidences of CNS complications were seen in patients with hematological malignancies （8. 9% ） and non-malignant hematological disorders （7.7 % ） （P = 1. 000 ）. Five of the 57 patients developed two kinds of CNS complications. The patterns of CNS complications included relapse （17 cases）, infections （15 cases）, cyclosporine or FK506 encephalopathy （9 cases）, cerebral hemorrhage （8 cases ）, cerebral infarction （2 cases）,Wernicke＇ s encephalopathy （1 case ）, skull fracture （1 case ）, drug-related meningitis （1 case）, hepatic encephalopathy （3 cases）, post-transplant lymphoproliferative disorder （1 case） and undetermined causes （4 cases）. The overall mortality in the patients who developed CNS compli
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第1期42-44,共3页
Chinese Journal of Internal Medicine
关键词
造血干细胞移植
中枢神经系统
并发症
Hematopoietic stem cell transplantation
Central nervous system
Complication
