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目的探讨异基因造血干细胞移植(allo-HSCT)后严重的(≥Ⅱ度)出血性膀胱炎(HC)的危险因素。方法对1997年4月至2004年12月期间的114例allo-HSCT患者的资料进行回顾性分析。以预处理实施之日为观察起点,至移植后+180d随访中止。选择11个临床参数,即:年龄、性别、疾病类型、供者类型、预处理方案、移植时疾病状态、急性移植物抗宿主病(aGVHD)、aGVHD的预防、预处理方案中抗胸腺细胞球蛋白(ATG)的应用、中性粒细胞及血小板植活时间做Cox单因素分析。将在单因素分析中P<0.1作为有统计学意义的因素进行Cox多因素回归分析。移植后180d内HC累计发生率的计算应用Kaplan-Meier法。结果(1)114例患者中有29例发生HC,+180d内HC的累计发生率为26%,其中Ⅱ级12例,Ⅲ级11例,Ⅳ级6例。(2)单因素分析表明,以下因素与HC的发生密切相关:男性(RR=2.885,P=0.021)、年龄≤25岁(RR=3.265,P=0.002)、Ⅲ~Ⅳ度aGVHD(RR=4.039,P=0.002)、非血缘供者(RR=4.347,P=0.000)、加强的GVHD预防方案(RR=2.218,P=0.045)、疾病进展期(RR=2.668,P=0.009)。(3)对上述有统计学意义的因素进行Cox多因素分析,只有男性(RR=2.993,95%CI1.218~7.358;P=0.017)和非血缘供者(RR=4.478,95%CI2.049~9.786;P=0.000)为HC的独立危险因素。结论男性受者和非血缘供者的造血干细胞移植后发生HC的危险性显著增加。
Objective To investigate the risk factors of severe (≥ Ⅱ degree) hemorrhagic cystitis (HC) after allo-HSCT. Methods The data of 114 patients with allo-HSCT between April 1997 and December 2004 were analyzed retrospectively. The starting point of pretreatment was observed, and the follow-up was stopped at 180 days after transplantation. Eleven clinical parameters were selected, namely age, sex, type of disease, type of donor, pretreatment regimen, disease state at transplantation, acute graft versus host disease (aGVHD), prevention of aGVHD, Protein (ATG) application, neutrophil and platelet activation time Cox univariate analysis. Cox regression analysis was performed with P <0.1 in the univariate analysis as a statistically significant factor. The cumulative incidence of HC within 180 days after transplantation was calculated using the Kaplan-Meier method. Results (1) HC was found in 29 of 114 patients. The cumulative incidence of HC was + 26% within 180 days, of which 12 were in grade Ⅱ, 11 in grade Ⅲ and 6 in grade Ⅳ. (2) Univariate analysis showed that the following factors were closely related to the occurrence of HC: male (RR = 2.885, P = 0.021), age ≤25 years (RR = 3.265, P = 0.002) (RR = 2.218, P = 0.045), disease progression (RR = 2.668, P = 0.009). There was no significant difference between the two groups (P> 0.05). (3) The Cox multivariate analysis of the above-mentioned statistically significant factors, only men (RR = 2.993, 95% CI1.218 ~ 7.358; P = 0.017) and non-blood donors (RR = 4.478,95% CI2. 049 ~ 9.786; P = 0.000) were independent risk factors for HC. Conclusion There is a significant increase in the risk of HC after hematopoietic stem cell transplantation in male recipients and non-blood donors.