CAJ | 학술논문

目的探讨异基因造血干细胞移植(allo-HSCT)后中枢神经系统(CNS)并发症的病因、临床特点及高危因素.方法观察68例allo-HSCT患者CNS并发症的发生情况及特点,并分析其原因和高危因素.结果 69例患者allo-HSCT后6个月内8例发生CNS并发症,发生率11.6％.其中CNS并发症发生率在HLA全相合及不全相合组分别为4.9％(2/41)和21.4％(6/28)(P＜0.05),在合并移植物抗宿主病(GVHD)≤2度和＞2度组分别为6.7％(4/9)、44.4％(4/60)(P＜0.01).CNS并发症在年龄≤14岁和＞14岁组、用或未用抗人胸腺球蛋白组、疾病稳定或进展组、预处理含或不含白消安组各组内比较差异均无统计学意义(均P＞0.05).allo-HSCT最常见的CNS并发症是癫痫和颅内感染,其次为颅内出血.结论 allo-HSCT中HLA配型不全相合及发生GVHD＞2度均是发生CNS并发症的高危因素；癫痫、颅内感染和颅内出血是allo-HSCT常见的CNS并发症.
목적 탐토이기인조혈간세포이식(allo-HSCT)후중추신경계통(CNS)병발증적병인、림상특점급고위인소.방법 관찰68례allo-HSCT환자CNS병발증적발생정황급특점,병분석기원인화고위인소.결과 69례환자allo-HSCT후6개월내8례발생CNS병발증,발생솔11.6％.기중CNS병발증발생솔재HLA전상합급불전상합조분별위4.9％(2/41)화21.4％(6/28)(P＜0.05),재합병이식물항숙주병(GVHD)≤2도화＞2도조분별위6.7％(4/9)、44.4％(4/60)(P＜0.01).CNS병발증재년령≤14세화＞14세조、용혹미용항인흉선구단백조、질병은정혹진전조、예처리함혹불함백소안조각조내비교차이균무통계학의의(균P＞0.05).allo-HSCT최상견적CNS병발증시전간화로내감염,기차위로내출혈.결론 allo-HSCT중HLA배형불전상합급발생GVHD＞2도균시발생CNS병발증적고위인소；전간、로내감염화로내출혈시allo-HSCT상견적CNS병발증.
Objective To analyse the etiology,clinical characteristics and risk factors of central nervous system (CNS) complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The clinical features of CNS complications in patients who underwent allo-HSCT were observed,and analysis its causes and risk factors.Results 8 cases of CNS complications occured in 69 patients within 6 months after allo-HSCT and the incidence was 11.6 ％,the occurrence rate of CNS complications was 21.4 ％ (6/28) in HLA mismatched group,higher than HLA matehed group [49 ％ (2/41)] (P ＜ 0.05).Analogously,the incidence was 44.4 ％ (4/60) in patients with graft-versus-host disease (GVIID) (＞grade 2),which was significantly higher than patients with 2 or below grade 2 GVHD [6.7 ％ (4/9)] (P ＜ 0.01).But there was no significant difference in the incidence of CNS complications between ≤14 years old and ＞14 years old,with or without ATG,different stages of diseases,whether pretreatment with maryland respectively (P ＞0.05),either.Epilepsy and intracranial infection were the most common CNS complications in allo-HSCT,followed by intracranial hemorrhage.Conclusion HLA mismatched and above grade 2 GVHD are the risk factors of CNS complications in allo-HSCT.Epilepsy,intracranial infection and bleeding are common CNS complications in allo-HSCT.