急性白血病患者异基因造血干细胞移植后急性肾损伤的临床分析

目的 分析急性白血病患者异基因造血干细胞移植(allo-HSCT)后急性肾损伤(AKI)的发生率以及对预后的影响.方法 回顾性分析66例急性白血病患者行清髓性allo-HSCT后的肾功能及相关临床数据.根据RIFLE分层诊断标准评价肾脏功能,分为:肾功能损伤危险(AKI-R)、肾功能损伤(AKI-I)和肾功能衰竭(AKI-F).结果 allo-HSCT后100 d内,有37例(56.1%)受者发生AKI,其中AKI-R 19例(28.8%),AKb-I11例(16.7%)和AKI-F 7例(10.6%);发生AKI的中位时间为allo-HSCT后29 d(1～89 d).与预处理前(基线)血肌酐水平比较,66例受者移植后21 d开始血肌酐水平显著增高(P＜0.05).移植后100 d时,发生肝脏静脉闭塞病(HVOD)的受者与未发生HVOD受者AKI-F发生率分别为(55.56±22.22)%和(9.01±4.75)%(P＜0.01);胆红素总量增高的受者与未增高的受者AKI-F发生率分别为(68.75±24.54)%和(8.38±4.17)%(P＜0.01);血环孢素A(CsA)浓度＞0.416μmol/L的受者与血CsA浓度较低的受者AKI的发生率分别为(66.67±10.29)%和(44.44±8.28)%(P＜0.05);无AKI、AKI-R、AKI-I和AKI-F的受者存活率分别为(89.66±5.66)%、(83.88±8.54)%、(81.82±11.63)%和(42.86±18.7)%,AKI-F组明显低于其他组(P＜0.05).结论 AKI是allo-HSCT后的常见并发症,不同程度的AKI对受者的存活率影响不同.应用RIFLE分层诊断标准对不同程度的肾功能损伤进行分级评价,可以早期诊断AKI并监测肾损伤的进展情况.     

非清髓性外周血造血干细胞移植供者的护理

对5例HLA完全相合的非清髓性外周血造血干细胞移植及淋巴细胞采集的供者进行护理。结果5例供者均顺利完成外周血造血干细胞采集及淋巴细胞采集．无严重不良反应发生。提示术前做好心理护理、术前准备,术中注意不良反应的观察、及时补充钙剂,可保证造血干细胞及淋巴细胞的顺利采集。     

非清髓异基因外周造血干细胞移植治疗血液病三例

我们采用新的非清髓预处理方案对 3例 5 3～ 5 9岁的高龄血液病患者进行了非清髓异基因外周造血干细胞移植(NAST) ,获得成功 ,报告如下。3例患者 ,男 2例 ,女 1例 ,年龄分别为 5 9岁、5 3岁和 5 6岁 ,原发病为再生障碍性贫血 (简称“再障”) 2例、难治性急性髓系白血病 1例。 3例供、受者的HLA配型完全相合 ,均采用STR PCR定量方法检测供者细胞植入情况。2例再障的预处理方案为 :环孢素A(CsA) 5mg·kg-1·d-1,共 5d ,抗胸腺细胞球蛋白 (ATG ,武汉生物制品研究所 )15～ 2 0mg·kg-1·d-1,共 5d ,环磷酰胺 (CTX) 4 0～ 5 0mg·kg-1·…     

非清髓性异基因造血干细胞移植治疗恶性淋巴瘤

本文就非清髓性异基因造血干细胞移植治疗恶性淋巴瘤的机理、可行性、临床病例及研究进展进行了综述.     

非清髓性异基因造血干细胞移植治疗恶性淋巴瘤

本文就非清髓性异基因造血干细胞移植治疗恶性淋巴瘤的机理、可行性、临床病例及研究进展进行了综述。     

非清髓性造血干细胞移植后并发移植物抗宿主病的相关因素分析

目的 探讨和分析非清髓性造血干细胞移植(NST)后并发移植物抗宿主病(GVHD)的相关因素.方法 选择34例血液病患者,其中重型再生障碍性贫血(SAA)15例,重型β-地中海贫血(TM)1例,肿瘤性血液病18例;进行无关供者脐带血造血干细胞移植(UCBT)11例,同胞供者骨髓联合外周血干细胞移植7例,外周血造血干细胞移植(PBSCT)16例.移植前采用以抗胸腺细胞球蛋白(ATG)、抗淋巴细胞球蛋白(ALG)或者氟达拉滨强效免疫抑制为基础的非清髓性预处理方案.GVHD的预防采用短程的甲氨蝶呤(MTX)联合环孢素A(CsA).观察非清髓性造血干细胞移植后的临床特点以及急、慢性移植物抗宿主病的发生情况;分析发生慢性移植物抗宿主病(cGVHD)的相关因素.结果 NST的植入率为91.2%.移植后7例肿瘤性血液病患者形成了供、受者造血细胞混合嵌合体(MC),给予供者淋巴细胞输注(DLI)2～9次后,例由MC转变为供者造血细胞完全嵌合体(FDC).随访12(3～96)个月,共发生Ⅰ～Ⅱ度急性移植物抗宿主病(aGVHD)5例,GVHD 15例.经统计学分析,发现年龄大的肿瘤性血液病患者经以ATG为基础的NST后,再给予DLI,其cGVHD的发生率高,且合并感染,对治疗的反应差;而以氟达拉滨为基础的NST患者发生cGVHD后治疗反应较好.移植100 d前后患者分别死亡3例和5例,其中3例死于广泛性cGVHD.结论 患者的年龄大、有合并症、以ATG为基础的预处理方案、肿瘤性血液病是NST后患者并发cGVHD的危险因素.     

非清髓性造血干细胞移植后移植物抗宿主病的临床观察

目的 观察非清髓性造血干细胞移植（NST）后移植物抗宿主病（GVHD）的发生情况。方法 将18例患者分为3组：A组为6例重型再生障碍性贫血（SAA）成人患者，行无关供者脐血造血干细胞移植；B组为5例SAA患者，行同胞供者骨髓联合外周血造血干细胞移植；C组为7例肿瘤性血液病患者，其中3例行同胞供者骨髓移植，4例行外周血造血干细胞移植。均采用以抗胸腺细胞球蛋白或抗淋巴细胞球蛋白为基础的预处理方案。A组和B组应用环孢素A（CsA）和甲泼尼龙预防GVHD，C组应用CsA和甲氨蝶呤预防GVHD。C组形成混合性嵌合体后行供者淋巴细胞输注（DLI）。结果 A组有4例形成并维持混合性嵌合体状态，1例死于真菌性败血症，1例自动出院。移植后早期，B组有3例供者型嵌合体占94％以上，并在短期内转变并维持完全供者嵌合体状态，获得无病存活，其中1例在移植后8个月发生慢性GVHD；另2例行供者千细胞输注后，1例6个月后死于继发性纵隔淋巴瘤，1例造血功能恢复。C组患者早期均形成混合性嵌合体，获得血液学部分缓解，患者DLI前无急性GVHD发生，1例于2次DLI后死于严重感染，1例失访；另5例分别经过4、3、7、5、4次DLI，全部转为完全供者型嵌合体，并获得血液学完全缓解，4例并发慢性GVHD，2例并发急性GVHD。结论 对于SAA患者，NST的临床效果较好，GVHD的发生率较低；而对于肿瘤性血液病，NST后患者的早期死亡率低，急性GVHD发生率下降，但慢性GVHD和感染的发生率较高。     

非清髓性外周血干细胞移植后白血病复发的防治

目的探讨非清髓性造血干细胞移植后白血病复发的防治。方法7例合并有其它系统疾病的白血病患者接受非清髓性外周血干细胞移植,移植后采用环孢素A及短程甲氨蝶呤预防移植物抗宿主病(GVHD),造血细胞植入后,动态检测骨髓单个核细胞嵌合体的变化,根据嵌合体状态,采用供者淋巴细胞输注(DLI),并配合环孢素A用量的调整来防治白血病复发。结果7例患者移植后造血功能得到恢复,3例移植前合并的疾病有所加重,经处理缓解,移植早期相关并发症少而轻。移植后有3例嵌合体由混合嵌合体(MC)转为完全供者型嵌合体(CC),再转为MC,伴Ph染色体阳性,DLI5~6次后Ph染色体转为阴性,嵌合体状态又转为CC,其中2例发生广泛皮肤慢性GVHD;3例的嵌合体持续为CC,无复发,其中2例接受了1次DLI,此2例在环孢素A减量过程中发生GVHD;1例的嵌合体持续为MC,虽经3次DLI,但无效,患者死于白血病复发。结论非清髓性造血干细胞移植后应动态监测嵌合体状态,采用供者淋巴细胞输注,并配合环孢素A用量的调整,对白血病的复发有一定的效果。     

RIFLE标准对慢性粒细胞白血病清髓性异基因造血干细胞移植后急性肾损伤的评价及预后分析

目的 探讨慢性粒细胞白血病清髓性异基因造血干细胞移植（HSCT）后急性肾损伤（AKI）的发生率和危险因素及其对患者移植后6个月生存率的影响。 方法 应用RIFLE标准对93例慢性粒细胞白血病患者清髓性异基因HSCT后肾脏功能的变化情况进行回顾性分析。 结果 清髓性异基因HSCT后100 d内有39例（41.9%）患者发生AKI,其中AKI危险（AKI-R）24例（25.8%）,AKI损伤（AKI-I）10例（10.8%）,AKI功能衰竭（AKI-F）5例（5.4%）,中位时间为干细胞回输后40 d（1～96 d）。移植后发生≥Ⅲ度急性移植物抗宿主病（aGVHD）患者与<Ⅲ度aGVHD患者100 d内AKI发生率分别为（81.82±11.63）%和（36.59±5.32）%（P ＝ 0.0037）。移植后出现总胆红素增高患者与无增高患者100 d内AKI发生率分别为（72.73±13.43）%和（37.04±5.37）%（P ＝ 0.0192）。移植后发生≥Ⅲ度aGVHD是患者发生AKI的独立危险因素,其相对危险度（RR）为2.773[95%可信区间（CI）（1.073～7.167）,P ＝ 0.035];并且移植后发生≥Ⅲ度aGVHD患者发生AKI-I和AKI-F的RR为6.320[95%CI（1.464～27.291）,P ＝ 0.013]。移植后发生AKI患者100 d内病死率与无AKI患者差异有统计学意义（P ＝ 0.001）。移植后发生AKI-R、AKI-I和AKI-F的患者6个月的生存率分别为（86.96±7.02）%、（70.0±14.49）%和0（P ＝ 0.000）。 结论 AKI是慢性粒细胞白血病清髓性异基因HSCT后的重要并发症。移植后出现≥Ⅲ度aGVHD和总胆红素增高是发生AKI的影响因素。出现≥Ⅲ度aGVHD的患者易发生较重的AKI。移植后发生AKI程度越严重,患者6个月的生存率越低。RIFLE标准能提高早期诊断AKI的敏感性,并可监测肾功能进展情况,预测预后。     

非清髓性异基因外周血造血干细胞移植

目的　总结非清髓性异基因外周血造血干细胞移植 (NASCT)治疗白血病的经验。方法　对 10例白血病患者进行非清髓性预处理 ,预处理采用氟达拉滨 (或环磷酰胺 )、抗淋巴细胞球蛋白及白消安 ,然后施行NASCT。术后预防移植物抗宿主病 (GVHD)采用环孢素A(CsA)加短程甲氨蝶呤 (MTX)。结果　中性粒细胞于术后第 10～ 38d超过 0 .5× 10 9/L ,血小板于第 8～ 16d上升至 2 0× 10 9/L以上 ;4例患者具有 10 0 %供者细胞 ,6例为嵌合性植入 ;2例发生急性GVHD ,5例发生慢性GVHD ;3例发生细菌感染 ,2例发生巨细胞病毒感染 ,1例发生疱疹病毒感染 ,均治愈 ;1例患者死于白血病复发 ,2例患者死于多器官功能衰竭 ,5例患者完全缓解 ,2例患者部分缓解。结论　NASCT后造血功能恢复迅速 ,是治疗白血病的有效方法。     

Urine neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in hematopoietic stem cell transplantation patients

Abstract

Acute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21–73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk–Injury–Failure–Loss–End-stage renal disease and AKI Network criteria. We assessed uNGAL on days ?6, ?3, +3, +9 and +15. Time-dependant Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence. (HR?=?1.04 (1.008–1.07), p?=?0.01). There was a relation between uNGAL day?+?9 to baseline ratio and incidence of AKI (unadjusted HR?=?1.047 (1.012–1.083), p?<?0.01). The area under the receiver-operating characteristic curve for day?+?9 to baseline ratio was 0.86 (0.74–0.99, p?<?0.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum Cr raises by nearly 2 days.     

肝移植术后早期急性肾损伤的危险因素及与预后的关系

目的观察肝移植术后患者早期急性肾损伤(acute kidney injury,AKI)的发生情况,探讨其危险因素及预后影响。 方法回顾性分析2015年10月至2017年11月在南京医科大学第一附属医院肝脏外科进行肝移植术的患者的临床资料。应用改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes,KDIGO)2012年修订的AKI诊断和分期标准观察肝移植术后AKI的发生情况,并根据AKI情况将患者分为两组：急性肾损伤和非急性肾损伤组,使用Logistic回归分析患者术后AKI的危险因素。应用Kaplan-Meier生存曲线分析患者术后30 d、90 d及1年的预后。 结果本研究共纳入146例肝移植患者,术后67例发生AKI(45.9%),其中AKI 1期占70.1%,AKI 2期占22.4%,AKI 3期占7.5%;其中7例患者接受肾脏替代治疗(renal replacement therapy,RRT)(10.4%)。相比于非AKI患者及AKI 1期的患者,AKI 2～3期患者30 d及90 d生存率明显下降。多因素Logistic回归分析表明,术前血清肌酐(serum creatinine,Scr)升高、国际标准化比值(international normalized ratio,INR)升高、术后天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)升高及术后24 h血红蛋白降低为AKI发生的独立危险因素,并且基于AST峰值评估的肝脏缺血再灌注损伤(hepatic ischemia-reperfusion injury,HIRI)的严重程度与AKI的发生有关。 结论肝移植术后AKI发生率高,并且与患者短期的预后有关。关注AKI发生的危险因素,有助于进一步采取积极有效的干预措施,对提高肝移植术后预后有着重要的意义。     

单中心住院患者急性肾损伤患病现况调查及预后分析

目的探讨住院患者急性肾损伤(acute kidney injury,AKI)患病及预后情况,并对预后相关的危险因素进行分析。方法通过石河子大学医学院第一附属医院检验科数据检索系统筛选出2015年1月至2015年12月所有住院患者58 444例,根据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)发布的最新AKI临床指南中血肌酐的定义标准,对于符合的患者组成队列研究,回顾性分析住院患者AKI的患病情况,采用Logistic回归分析患者死亡和肾脏预后的危险因素。结果符合入选标准的AKI患者609例,AKI患病率1.04%(609/58 444),男、女发病比率为2.07:1,平均年龄(66.3±16.1)岁。根据KDIGO指南AKI分期标准,Ⅰ期249例(占40.9%),Ⅱ期263例(占43.2%),Ⅲ期97例(占15.9%)。导致住院患者发生AKI的原因中,肾前性原因431例(占70.6%),肾性原因131例(占21.5%),肾后性原因48例(占7.9%)。在发生AKI第7天观察时,病死率25.5%(155/609);以出院作为观察节点时,病死率29.1%(177/609);在观察患者肾脏预后中,29.9%的患者肾功能未恢复,18.7%的患者肾功能完全恢复,41.2%的患者肾功能部分恢复。多因素Logistic回归分析,年龄(OR=1.598)、AKI分期(OR=1.538)、昏迷(OR=2.659)、慢性肝脏病(OR=2.134)是患者死亡的独立危险因素。肾外脏器衰竭(P0.01,OR=2.548,95%CI:1.717~3.783)是患者肾功能未恢复的独立危险因素。结论 AKI是住院患者越来越普遍并且或将成为影响预后的严重并发症。年龄、AKI分期、昏迷、慢性肝脏病是患者死亡的独立危险因素。肾外脏器衰竭是患者肾功能未恢复的独立危险因素。     

Acute kidney injury in hematopoietic cell transplantation

Hematopoietic cell transplantation is becoming an increasingly common treatment modality for a variety of diseases. However, patient survival may be limited by substantial treatment-related toxicities, including acute kidney injury (AKI). AKI can develop in approximately 70% of patients posttransplant and is associated with an increased risk of morbidity and mortality. The development of AKI varies depending on the type of conditioning regimen used and the donor cells infused at the time of transplant, and the etiology often is multifactorial. Epidemiology, risk factors for development, pathogenesis, and potential treatment options for AKI in the hematopoietic cell transplantation population are reviewed as well as newer data on early markers of renal injury. As the indications for and number of transplants performed each year increases, nephrologists and oncologists will have to work together to identify patients who are at risk for AKI to both prevent its development and initiate therapy early to improve outcomes.     

Hematopoietic stem cell transplantation in patients with chronic kidney disease

Patients with significant medical comorbidities such as chronic kidney disease (CKD) traditionally have been excluded from hematopoietic stem cell transplantation (HSCT) because of unacceptably high transplant-related morbidity and mortality, an exclusion that can have enormous consequences for patients with CKD from myeloma in particular. Much of the excess HSCT-related morbidity among CKD patients relates to the toxic effects of conditioning regimens, which have a narrow therapeutic index even in patients with normal renal function. Common posttransplant complications are more challenging to prevent and manage in patients with CKD. In selected centers, autologous HSCT is performed with some frequency in patients with advanced CKD and even dialysis-dependent end-stage renal disease (ESRD), with acceptable outcomes, but cure from malignancy rarely is obtained. Allogeneic transplants using reduced-intensity conditioning regimens are being used with increasing frequency in patients with CKD, for both nonmalignant and malignant conditions, relying in the latter case on a graft-versus-malignancy effect to eliminate residual malignancy. In patients with ESRD from myeloma who have suitable donors, simultaneous allogeneic HSCT and kidney transplantation from a human leukocyte antigen-identical sibling provides the opportunity to treat both the malignant condition and the ESRD, avoiding the risks of posttransplant care in a dialysis-dependent patient and freeing the patient of the subsequent burdens of both ongoing dialysis and immunosuppression.     

Implications of acute kidney injury after heart transplantation: what a surgeon should know

Objective: Data regarding risks and consequences of acute kidney injury (AKI) after cardiac transplantation are dismissingly few and unclear. This study defined the incidence, risk factors and prognostic implication of AKI in a single-center cohort operated on between January 1999 and December 2008. Methods: Data from 307 consecutive recipients (mean age: 47.42 ± 13.58, 20.5% female, 18.9% diabetics, 19.5% with previous cardiac operations, 26.4% hospitalized, 78.4 ± 33.7 ml min⁻¹ preoperative glomerular filtration rate (eGFR)) were analyzed using multivariable logistic regression modeling. AKI was defined according to RIFLE (Risk, Injury, and Failure; and Loss, and End-stage kidney disease) criteria. Results: RIFLE scores of I or F were detected in 14%, and continuous venovenous hemofiltration was needed in 6.1%. Risk factors for AKI were: previous cardiac operation (odds ratio (OR) 2.35; 95% confidence interval (CI), 1.11–4.9), blood transfusion (OR 1.08; 95% CI, 1.011–1.16), troponin I release >10 (OR 1.031; 95% CI, 1.001–1.064), length of ischemic time (OR 1.008; 95% CI, 1.011–1.16). Overall hospital mortality averaged 7.8% and overall 1-year mortality was 10.4%; both mortality rates increased with each RIFLE stratification (Normal 3.4%, RIFLE R = 7.1%; RIFLE I = 25.7%; and RIFLE F = 37.5% and Normal 5.6%, RIFLE R = 11.8%, RIFLE I = 25.7%, and RIFLE F = 37.5%, respectively). AKI proved independent predictors of both early and 1-year mortality. The burden of AKI significantly affected 1-year kidney function (Δ preoperative GFR − 1-year GFR in AKI vs no AKI = −25.872 ± 22.54 vs −7.968 ± 34.18, p = 0.015). Conclusions: AKI is a highly prevalent and prognostically important complication. Some of the risk factors for AKI identified may be modifiable.     

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

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.

Abstract：

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.     

造血干细胞移植后并发感染121例的临床分析

目的探讨造血干细胞移植(HSCT)后并发感染的临床病原学特点和相关危险因素。方法共有121例造血系统疾病患者接受HSCT,其中51例行异基因外周造血干细胞移植,40例行异基因骨髓移植,4例行异基因外周血造血干细胞和骨髓混合移植,5例行脐带血移植,16例行自体造血干细胞移植,5例行自体CD34~+细胞移植。患者均采用化疗进行预处理。采用短程甲氨蝶呤联合环孢素A预防移植物抗宿主病(GVHD),部分病例加用达利珠单抗或抗淋巴细胞球蛋白。结果121例患者中,116例患者获得造血重建,3例移植失败,2例在移植物植活前因严重感染死亡。移植后60d内,83例(68．6%)共发生感染97次,64例(77．1%)发生感染时中性粒细胞＜0．5×10~9/L,患者均有不同程度的发热。口咽黏膜和呼吸道(上、下呼吸道)是最常见的感染部位,占64．9%。21例患者的23次感染中,共分离出20株细菌和7株真菌,65%为革兰氏阴性杆菌。10例患者并发巨细胞病毒感染。因感染死亡的患者共8例,均为异基因造血干细胞移植患者。发生Ⅱ～Ⅳ度急性GVHD患者的感染发生率(88．9%,24/27)高于0～Ⅰ度急性GVHD患者(60．3%,44/73,P＜0．01)。结论造血干细胞移植后60d内的感染多发生于粒细胞缺乏期；口咽黏膜炎和呼吸道是常见感染部位,下呼吸道感染者的死亡率高,侵袭性真菌感染者的预后不佳；发生Ⅱ～Ⅳ度急性GVHD者有较高的感染发生率。