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华西医学  2011 

异基因造血干细胞移植后出血性膀胱炎的危险因素

, PP. 1767-1773

Keywords: 异基因造血干细胞移植,迟发性出血性膀胱炎,BK病毒

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Abstract:

【】 目的 分析异基因造血干细胞移植术(allogeneichematopoieticstemcelltransplantation,allo-HSCT)后出血性膀胱炎(hemorrhagiccystitis,HC)相关的危险因素,动态监测受者尿BK病毒(BKvirus,BKV),分析其与HC发病的关系。 方法 回顾性分析2003年3月-2008年1月期间接受allo-HSCT的121例患者的资料,选择8个临床参数年龄、性别、疾病类型、移植时疾病状态、供者类型、预处理方案、急性移植物抗宿主病(acutegraft-versus-hostdisease,aGVHD)、aGVHD的预防方案作COX回归分析。采用SYBRGreen染料实时荧光定量聚合酶链反应法对2006年9月-2008年1月42例allo-HSCT患者尿BKV载量进行动态监测,分析被检查者尿液BKV基因载量与HC发生以及严重程度的关系。 结果 121例患者中有24例发生HC,发病时间为术后0~63d,中位时间40d;持续时间7~150d,中位时间22d。Ⅱ~Ⅳ度aGVHD为HC的独立危险因素RR=8.304,95%CI(1.223,56.396),P=0.030。allo-HSCT受者尿液中BKV检出率为100%(42/42)。与正常人及未发生HC的allo-HSCT受者相比,HC患者尿中BKV基因载量具有更高平均峰值。 结论 Ⅱ~Ⅳ度aGVHD,尿中BKVDNA高载量与HC的发生有相关性。【Abstract】 Objective Toidentifytheriskfactorsforhemorrhagiccystitis(HC)afterallogeneichematopoieticstemcelltransplantation(allo-HSCT),anddefinethequantitativerelationshipbetweenBKvirus(BKV)DNAloadwithHC. Methods Themedicalrecordsof121patientsundergoingallo-HSCTfromMarch2003toJanuary2008wereretrospectivelyanalyzed.EightclinicalparameterswereselectedforCOXregressionanalysis,includingage,sex,underlyingdisease,diseasestatusattransplant,donortype,conditioningregimen,acutegraft-versus-hostdisease(aGVHD),andGVHDprophylaxis.FromSeptember2006toJanuary2008,mid-streamurinesampleswerecontinuouslycollectedfrom42patientswithallo-HSCT.SYBRgreenreal-timepolymerasechainreaction,techniquewasutilizedtodefinethequantitativerelationshipbetweenBKVDNAloadandHC. Results Twenty-fouroutof121patientsdevelopedHC.Themediantimeofonsetwas40daysafterHSCT,rangedfrom0to63days.Thediseaselastedfor7to150days,withamediandurationof22days.GradeⅡ-ⅣaGVHDRR=8.304,95%CI(1.223,56.396);P=0.030wasidentifiedasanindependentriskfactorfortheoccurrenceofHC.BKVexcretionwasdetectedin100%(42/42)oftherecipientsofallo-HSCT.Whencomparedwithasymptomaticpatientsandallo-HSCTrecipientswithoutHC,patientswithHChadasignificantlyhighermeanpeakBKVDNAload. Conclusions PatientsareatanincreasedriskofdevelopingHCiftheyhavegradeⅡ-ⅣaGVHD.AcorrelationbetweentheloadofBKVandincidenceofHCmayexist.

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