CAJ | 학술논문

目的探讨异基因造血干细胞移植(allo-HSCT)患者移植前和预处理期间肝功能异常的特征及其与肝脏合并症和预后的关系.方法回顾性分析196例allo-HSCT治疗血液系统疾病患者,采集其移植前和预处理期间肝功能数据,观察其对造血重建、移植相关肝脏并发症、生存和移植相关死亡的影响.结果 196例患者中,38例移植前存在肝功能异常,159例预处理期间发生肝功能异常,28例(17.6％)出现3度肝损害,无4度肝损害出现.移植前和预处理期间肝功能异常对造血重建时间、肝静脉阻塞病(HVOD)、肝脏急性移植物抗宿主病(aGVHD)和慢性移植物抗宿主病(cGVHD)发生无显著影响.单因素分析显示年龄(P =0.022)、移植前疾病状态高危(P =0.003)、移植前AST(P=0.019)和TBil水平升高(P =0.015)、Ⅲ～Ⅳ度肝脏aGVHD(P=0.000)和HVOD(P=0.000)是影响总生存(OS)率的危险因素.多因素Cox回归分析显示移植前疾病状态为高危(P=0.002)、Ⅲ～Ⅳ度肝脏aGVHD(P=0.000)是影响OS率的独立危险因素,同时也是影响移植相关死亡(TRM)率的独立危险因素(P值分别为0.002和0.000),而移植前和预处理期间肝功能异常对OS率和TRM率无显著影响.结论 1～2度肝功能异常患者,在密切监测肝功能、充分保肝治疗及积极预防HVOD基础上,可考虑进行allo-HSCT.
목적 탐토이기인조혈간세포이식(allo-HSCT)환자이식전화예처리기간간공능이상적특정급기여간장합병증화예후적관계.방법 회고성분석196례allo-HSCT치료혈액계통질병환자,채집기이식전화예처리기간간공능수거,관찰기대조혈중건、이식상관간장병발증、생존화이식상관사망적영향.결과 196례환자중,38례이식전존재간공능이상,159례예처리기간발생간공능이상,28례(17.6％)출현3도간손해,무4도간손해출현.이식전화예처리기간간공능이상대조혈중건시간、간정맥조새병(HVOD)、간장급성이식물항숙주병(aGVHD)화만성이식물항숙주병(cGVHD)발생무현저영향.단인소분석현시년령(P =0.022)、이식전질병상태고위(P =0.003)、이식전AST(P=0.019)화TBil수평승고(P =0.015)、Ⅲ～Ⅳ도간장aGVHD(P=0.000)화HVOD(P=0.000)시영향총생존(OS)솔적위험인소.다인소Cox회귀분석현시이식전질병상태위고위(P=0.002)、Ⅲ～Ⅳ도간장aGVHD(P=0.000)시영향OS솔적독립위험인소,동시야시영향이식상관사망(TRM)솔적독립위험인소(P치분별위0.002화0.000),이이식전화예처리기간간공능이상대OS솔화TRM솔무현저영향.결론 1～2도간공능이상환자,재밀절감측간공능、충분보간치료급적겁예방HVOD기출상,가고필진행allo-HSCT.
Objective To investigate the characteristics of liver dysfunction pre-transplant and during conditioning period and its impacts on transplantation related hepatic complication,overall survival (OS) and transplant-related mortality (TRM).Methods A total of 196 patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Peking University First Hospital were analyzed retrospectively.Liver function test for each patient was examined pre-transplant and during the period of conditioning.The correlation of liver dysfunction with hepatic complications,OS and TRM rates were analyzed.Results Liver dysfunction before transplantation was found in 38 (19.8％,38/192) patients,while damage of liver function during conditioning was found in 159 (81.1％) patients,28 of whom developed grade 3 hepatic dysfunction.There was no life-threatening impairment of liver function.No matter pre-transplant or during conditioning,liver dysfunction did not suggest apparent influence on the engraftment of neutrophil or platelet or the incidence of hepatic complications including hepatic veno occlusive disease (HVOD),acute graft versus host disease (aGVHD) and chronic graft versus host disease (cGVHD).Univariate analysis revealed that factors affecting OS rate included age (P =0.022),high risk stage (P =0.003),AST and TBil elevation before transplantation (P =0.019 and 0.015 respectively),Ⅲ-Ⅳ hepatic aGVHD (P =0.000) and HVOD(P =0.000).Multivariate Cox regression analysis revealed that high risk stage (P =0.002) and Ⅲ-Ⅳ hepatic aGVHD (P =0.000) were independent prognostic risk factors affecting both OS rate and TRM rate,while liver dysfunction before transplantation or during conditioning period had no apparent influence on OS rate or TRM rate.Conclusion Allo-HSCT would be administrated for the patients with mild impairment of liver function grade 1 and 2.