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背景:出血性膀胱炎是造血干细胞移植后常见并发症之一,探讨其临床特征及发病的危险因素对改善造血干细胞移植效果有重要应用意义。目的:观察小儿造血干细胞移植后出血性膀胱炎发病情况,并分析其临床特点以及发病危险因素。设计:病例分析。单位:中山大学附属第二医院儿科造血干细胞移植中心。对象:选择 1998-10/2004-06 在中山大学附属第二医院儿科 HSCT 中心 88 例接受脐血移植与外周血造血干细胞移植患儿,男 49 例,女 39例,年龄 2~18 岁,平均 8.0 岁。所有患儿家属对治疗知情同意。实验经过医院伦理委员会批准许可。方法:①患儿预处理方案主要有环磷酰胺(120~200 mg/kg)和马利兰(Bu,14~20 mg/kg)组成为主的化疗方案,以及环磷酰胺联合全淋巴照射(2-8Gy)或全身照射(2-8Gy)组成的放疗方案。②按文献[7]及[8]标准诊断及对出血性膀胱炎分类;观察患者出血性膀胱炎发生率、临床特征、实验室检查及治疗与转归;分析年龄、性别、供受者人类白细胞抗原配型、移植病种、移植类型、移植方式、急性移植物抗宿主病的发生、巨细胞病毒感染对出血性膀胱炎发生的影响。主要观察指标:①患儿出血性膀胱炎发生率。②临床特征与实验室检查。③治疗与转归。④出血性膀胱炎发生的危险因素。结果:纳入患儿 88 例均进入结果分析。①出血性膀胱炎发生率:16例(18.2%,16/88)患儿发生出血性膀胱炎,其中轻度 11 例(68.7%),重度 5 例。②临床特征与实验室检查:患儿均有血尿,其中典型尿频、尿急、尿痛及肉眼血尿 8 例(50.0%);肉眼血尿 10 例(62.5%);11例蛋白尿(+~+++),7 例白细胞增高。③治疗与转归:所有出血性膀胱炎患儿均痊愈,病程 2~53 d。④出血性膀胱炎发生危险因素:受者移植年龄≥6 岁、急性移植物抗宿主病阳性及巨细胞病毒感染出血性膀胱炎发生率分别高于年龄<6 岁、GVHD 阴性及巨细胞病毒未感染患儿,差异有统计学意义(P < 0.05~0.01)。结论:①儿童造血干细胞移植后出血性膀胱炎有其自身的临床特征,预后多良好。②受者移植年龄≥6 岁、急性移植物抗宿主病阳性、巨细胞病毒感染可能为其发生的危险因素。
BACKGROUND: Hemorrhagic cystitis is one of the most common complications after hematopoietic stem cell transplantation. It is important to explore the clinical features and the risk factors for hematopoietic stem cell transplantation to improve hematopoietic stem cell transplantation. Objective: To observe the incidence of hemorrhagic cystitis after pediatric hematopoietic stem cell transplantation and to analyze its clinical features and risk factors. Design: Case Analysis. Unit: Second Affiliated Hospital of Sun Yat-sen Pediatric Hematopoietic Stem Cell Transplant Center. PARTICIPANTS: A total of 88 males and 39 females, aged 2-18 years, with an average of 88 males and 85 females undergoing cord blood transplantation and peripheral blood stem cell transplantation were enrolled in the pediatric HSCT center of the Second Affiliated Hospital of Sun Yat-sen University from October 1998 to June 2004. 8.0 years old. All children with family members have informed consent for the treatment. The experiment was approved by the Hospital Ethics Committee. Methods: ①The pretreatment regimen in children mainly consisted of cyclophosphamide (120-200 mg / kg) and melitrine (Bu, 14-20 mg / kg) -8 Gy) or systemic irradiation (2-8 Gy). ② according to the literature [7] and [8] standard diagnosis and classification of hemorrhagic cystitis; observe the incidence of hemorrhagic cystitis patients, clinical features, laboratory tests and treatment and outcome; analysis of age, gender, Leukocyte antigen matching, transplant disease, transplantation type, transplantation mode, acute graft-versus-host disease, cytomegalovirus infection on the occurrence of hemorrhagic cystitis. MAIN OUTCOME MEASURES: ① incidence of hemorrhagic cystitis in children. ② clinical features and laboratory tests. ③ treatment and prognosis. ④ hemorrhagic cystitis risk factors. Results: 88 cases were included in the analysis of results. ① The incidence of hemorrhagic cystitis: Hemorrhagic cystitis occurred in 16 cases (18.2%, 16/88), of which 11 were mild (68.7%) and 5 were severe. ② Clinical features and laboratory tests: Hematuria was found in all children, including 8 cases of typical urinary frequency, urinary urgency, dysuria and gross hematuria (50.0%), 10 cases of gross hematuria (62.5%), 11 cases of proteinuria ++), 7 cases of leukocytosis. ③ treatment and prognosis: All children with hemorrhagic cystitis recovered, duration of 2 ~ 53 d. ④ risk factors for hemorrhagic cystitis: recipients of transplant age ≥ 6 years old, acute graft-versus-host disease and cytomegalovirus infection were higher than the incidence of hemorrhagic cystitis <6 years of age, GVHD negative and cytomegalovirus Infected children, the difference was statistically significant (P <0.05 ~ 0.01). Conclusion: ① hematopoietic stem cell transplantation in children with hemorrhagic cystitis has its own clinical features, the prognosis is more good. ② recipients aged ≥ 6 years of age, acute graft-versus-host disease-positive, cytomegalovirus infection may be its risk factors.