异基因造血干细胞移植后并发出血性膀胱炎的高危因素和防治措施
이기인조혈간세포이식후병발출혈성방광염적고위인소화방치조시
Hemorrhagic cystitis following hematopoietic stem cell transplantation: risk factors and prophylaxis measures
  • 万方数据
    中华器官移植杂志 중화기관이식잡지
    CHINESE JOURNAL OF ORGAN TRANSPLANTATION
    2011年 3期 148-151 ,共4页

    施继敏%景晶%罗依%谭亚敏%何静松%郑伟燕%谢万灼%李黎%郑高锋%朱晓黎%韩晓雁%来晓瑜%叶秀锦%张洁%蔡真%林茂芳%黄河

    시계민%경정%라의%담아민%하정송%정위연%사만작%리려%정고봉%주효려%한효안%래효유%협수금%장길%채진%림무방%황하

    造血干细胞移植%膀胱炎%危险因素%治疗 造血榦細胞移植%膀胱炎%危險因素%治療
    조혈간세포이식%방광염%위험인소%치료
    Hematopoietic stem cell transplantation%Cystitis%Risk factors%Therapy
    目的 评估改良的水化碱化方案对预防和治疗非亲缘异基因造血干细胞移植(URD-HSCT)后出血性膀胱炎(HC)的效果及安全性,探讨URD-HSCT后并发HC的危险因素.方法 151例血液系统恶性疾病患者接受了URD-HSCT,所有患者移植前均接受白消安+环磷酰胺(BuCy2)方案预处理.在使用环磷酰胺(Cy)过程中,所有患者均接受改良的水化碱化输液方案,分别在静脉滴注Cy后0、3、6、9、12 h分5次静脉注射美司钠,总量为Cy总量的120%～160%;于开始使用Cy时至结束后24 h(共计72 h)经中心静脉持续输液,输液量5000 ml·m-2·d-1,匀速输注,每500 ml液体中加入50 g/L碳酸氢钠20 ml,间断应用利尿剂,保持液体出入量平衡;每小时测尿pH值,保持尿pH值＞7.5.结果 URD-HSCT后共有26例患者发生HC,发生率为17.2%(26/151),中位发病时间为40d(8～89 d),无患者发生早发性HC.移植后26例HC患者再次接受改良的水化碱化尿液治疗,部分患者接受膀胱持续冲洗,所有患者均治愈,无患者因HC而死亡.经统计分析表明,以下因素与HC的发病明显相关:男性患者,相关系数(OR)值=3.093,95%可信区间(CI)为1.145～8.353,P＜0.05;急性GVHD,OR值=18.044,95%CI为3.952～82.392,P＜0.01;≥30岁,OR值=6.077,95%CI为1.585～23.299,P＜0.01.结论 改良的水化碱化方案是预防和治疗URD-HSCT后HC的安全有效的措施,尤其是由Cy预处理引起的早发性HC;男性患者、年龄≥30岁以及移植后并发急性GVHD是引起HC的危险因素.
    목적 평고개량적수화감화방안대예방화치료비친연이기인조혈간세포이식(URD-HSCT)후출혈성방광염(HC)적효과급안전성,탐토URD-HSCT후병발HC적위험인소.방법 151례혈액계통악성질병환자접수료URD-HSCT,소유환자이식전균접수백소안+배린선알(BuCy2)방안예처리.재사용배린선알(Cy)과정중,소유환자균접수개량적수화감화수액방안,분별재정맥적주Cy후0、3、6、9、12 h분5차정맥주사미사납,총량위Cy총량적120%～160%;우개시사용Cy시지결속후24 h(공계72 h)경중심정맥지속수액,수액량5000 ml·m-2·d-1,균속수주,매500 ml액체중가입50 g/L탄산경납20 ml,간단응용이뇨제,보지액체출입량평형;매소시측뇨pH치,보지뇨pH치＞7.5.결과 URD-HSCT후공유26례환자발생HC,발생솔위17.2%(26/151),중위발병시간위40d(8～89 d),무환자발생조발성HC.이식후26례HC환자재차접수개량적수화감화뇨액치료,부분환자접수방광지속충세,소유환자균치유,무환자인HC이사망.경통계분석표명,이하인소여HC적발병명현상관:남성환자,상관계수(OR)치=3.093,95%가신구간(CI)위1.145～8.353,P＜0.05;급성GVHD,OR치=18.044,95%CI위3.952～82.392,P＜0.01;≥30세,OR치=6.077,95%CI위1.585～23.299,P＜0.01.결론 개량적수화감화방안시예방화치료URD-HSCT후HC적안전유효적조시,우기시유Cy예처리인기적조발성HC;남성환자、년령≥30세이급이식후병발급성GVHD시인기HC적위험인소.
    Objective To investigate the efficacy and safety of the optimal alkalized hydration solution for hemorrhagic cystitis (HC) following unrelated donor allogeneic hematopoietic stem cell transplantation (URD-HSCT), and the risk factors and prophylaxis measures about HC.Methods The clinical data of 151 HC patients who underwent URD-HSCT were retrospectively analyzed. All patients were given busulfan/cyclophosphamide (BuCy)-based conditioning regimen.During Cy therapy, all patients were given the optimal alkalized hydration solution to prevent HC.MESNA was given intravenously after administration of Cy at 0, 3, 6, 9, 12 h, and its total dose was administration of Cy to 24 h under the ECG monitoring. Each 500 ml liquid contained 50 g/L sodium bicarbonate 20 ml. Urinary pH value was monitored every one hour (keeping urine pH＞7. 5). Results None of early onset HC occurred. Twenty-six of 151 (17. 2 %) patients developed late onset HC, and the median onset time was 40 (8～89) days after transplantation. During the therapy, no symptoms of the circulatory system, no congestive heart failure and no acid-base electrolyte imbalance occurred. All HC patients after re-hydration, diuretic, and (or) continuous bladder irrigation and other indwelling catheter after treatment, were cured. The statistical analysis showed that the following factors were significantly associated with HC: male (OR = 3. 093, 95 % CI, 1. 145～8.353, P＜0. 05), acute graft versus host disease (aGVHD) (OR= 18. 044, 95 % CI, 3. 952～～82. 392, P＜0. 01), and ≥30-yearold (OR = 6. 077, 95 0% CI, 1. 585～23. 299, P＜0. 01). Conclusion The optimal alkalized hydration solution is safe and effective to prevent early onset HC following URD-HSCT in combination with BuCy regimen. Male, aGVHD and ≥30-year-old were the risk factors for HC.
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