CAJ | 학술논문

目的：分析综合预防策略降低半相合造血干细胞移植（HSCT）相关口腔黏膜炎（OM）的发生情况及其影响因素，探讨综合预防策略对异基因HSCT过程中OM的预防价值。方法回顾性分析2010年1月1日至2011年12月31日在北京大学人民医院血液科接受异基因HSCT的721例患者，所有患者均采用综合预防的策略预防OM。结果共有315例患者（43.7%）在HSCT过程中发生OM，中位发生时间为移植后第5天。分别有173例占54.9%、91例占28.9%、37例占11.7%和14例占4.4%患者发生Ⅰ度、Ⅱ度、Ⅲ度及Ⅳ度OM。舌部为OM的最常见部位。共有111例患者存在多部位的溃疡（≥2个部位）。在多因素分析中，中性粒细胞缺乏时间≥15 d是移植过程中出现OM的唯一的独立危险因素，风险比（hazard ratio，HR）=1.5，P<0.01；中性粒细胞在移植后12 d或以后才植入与OM持续时间较长（≥8 d）显著相关，HR=2.1，P<0.01；年龄≥20岁是Ⅲ~Ⅳ级OM的独立危险因素，HR=2.7，P<0.05。结论实施综合预防的策略能有效降低异基因HSCT过程中OM的发生。
목적：분석종합예방책략강저반상합조혈간세포이식（HSCT）상관구강점막염（OM）적발생정황급기영향인소，탐토종합예방책략대이기인HSCT과정중OM적예방개치。방법회고성분석2010년1월1일지2011년12월31일재북경대학인민의원혈액과접수이기인HSCT적721례환자，소유환자균채용종합예방적책략예방OM。결과공유315례환자（43.7%）재HSCT과정중발생OM，중위발생시간위이식후제5천。분별유173례점54.9%、91례점28.9%、37례점11.7%화14례점4.4%환자발생Ⅰ도、Ⅱ도、Ⅲ도급Ⅳ도OM。설부위OM적최상견부위。공유111례환자존재다부위적궤양（≥2개부위）。재다인소분석중，중성립세포결핍시간≥15 d시이식과정중출현OM적유일적독립위험인소，풍험비（hazard ratio，HR）=1.5，P<0.01；중성립세포재이식후12 d혹이후재식입여OM지속시간교장（≥8 d）현저상관，HR=2.1，P<0.01；년령≥20세시Ⅲ~Ⅳ급OM적독립위험인소，HR=2.7，P<0.05。결론실시종합예방적책략능유효강저이기인HSCT과정중OM적발생。
Objective To investigate the comprehensive prevention strategy in the prevention of oral mucositis (OM) during allogeneic hematopoietic stem cell transplantation (HSCT). Methods A total of 721 patients who received HSCT from January 2010 to December 2011 at the Institute of Hematology, Peking University were enrolled. All the patients received the comprehensive prevention strategy of OM. Results A total of 315 patients (43.7 percents) suffered from OM during HSCT, the median time from HSCT to OM occurrence was 5 days. There were 173 (54.9 percents), 91(28.9 percents), 37(11.7 percents), and 14(4.4 percents) patients suffered from gradeⅠ,Ⅱ,Ⅲ, and IV OM, respectively. Tongue OM was most common. A total of 111 patients suffered from multiple OM (≥2 locations). Multiplicity showed that duration of agranulocytosis≥15 days was the only independent risk factor of OM in HSCT [ hazard ratio (HR) value 1.5, P<0.05 ]. Neutrophil engraftment time≥12 days was significantly associated with prolonged OM (≥8 days) (HR=2.1, P<0.05). Patient age ≥20 was independent risk factor for occurrance of grade Ⅲ-Ⅳ OM (HR=2.7, P<0.05). Conclusions Comprehensive prevention strategy can overcome the risk factors of OM and prevent the occurrence of OM during HSCT.