南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (06): 807-.

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造血干细胞移植后硬皮病样慢性移植物抗宿主病的临床表现

杨欢，李志涛，林韧，范志平，黄芬，江千里，周红升，刘启发，孙竞   

  • 出版日期:2016-06-20 发布日期:2016-06-20

Sclerodermatous chronic graft-versus-host disease after hematopoietic stem cell transplantation: incidence, clinical characteristics and risk factors

  • Online:2016-06-20 Published:2016-06-20

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摘要： ：目的探讨异基因造血干细胞移植（allo-HSCT）后硬皮病样慢性移植物抗宿主病（ScGVHD）的发病率、危险因素。方法 对我院2012 年1 月~2014 年12 月之间进行allo-HSCT 的259 例患者发生ScGVHD 的情况进行回顾性分析。结果134 例 （51.7%）发生慢性移植物抗宿主病（cGVHD），其中22例为硬皮病型，即ScGVHD在移植患者中的发病率为8.49%（22/259）、在 cGVHD患者中的发病率为16.4%（22/134）。ScGVHD出现的中位时间为移植后12.5（4~28）月。单因素分析结果提示预处理方 案是否含全身照射（TBI）（P=0.031）、GVHD预防方案是否含霉酚酸酯（MMF）（P=0.046）、cGVHD（P=0.008）的发生、供者淋巴 细胞回输（DLI）（P=0.001）均与ScGVHD的发生具有相关性。多因素分析确定cGVHD[相对危险度（RR）=3.512，95%可信区间 （CI）=1.235~9.987，P=0.018]和DLI（RR=5.217，95% CI=1.698~16.029，P=0.004）为ScGVHD 发病的独立危险因素。结论 ScGVHD是移植后一种较为少见的并发症，移植物抗宿主病（GVHD）和DLI是其发病的独立危险因素。

Abstract: Objective To investigate the incidence and risk factors of sclerodermatous chronic graft-versus-host disease (ScGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 259 patients undergoing allo-HSCT in Nanfang Hospital between January, 2012 and December, 2014 were analyzed. Results Chronic GVHD following allo-HSCT occurred in 134 (51.7%) cases, among whom 22 patients showed sclerodermatous features at a median of 12.5 months (range 4-28 months) after the transplantation. The overall incidence of ScGVHD was 8.49% (22/259) in the recipients and 16.4% (22/134) in those with cGVHD. Univariate analysis showed that the conditioning regimen with total body irradiation (P=0.031), GVHD prophylaxis with MMF (P=0.046), presence of chronic GVHD (P=0.008), and donor lymphocyte infusion (P=0.001) were all closely associated with the occurrence of ScGVHD. Multivariate analysis identified chronic GVHD (RR=3.512, 95%CI: 1.235-9.987, P=0.018) and donor lymphocyte infusion (RR=5.217, 95%CI: 1.698-16.029, P= 0.004) as the independent risk factors of ScGVHD. Conclusion ScGVHD following allo-HSCT is not a common complication, and cGVHD and donor lymphocyte infusion are the independent risk factors for ScGVHD.