异基因造血干细胞移植后早期特发性肺炎综合征的危险因素及发病机制

目的 研究异基凶造血干细胞移植(allo-HSCT)术后早期特发性肺炎综合征(IPS)的独立危险因素及发病机制.方法 同顾件分析192例allo-HSCT受者的临床资料,观察术后急性移植物抗宿主病(aGVHD)和IPS的发牛情况及其临床表现,对患者年龄、性别、原发病、移植时疾病状态(高危组70例,疾病处于难治、未缓解状态;标危组122例,疾病处于缓解状态)、供者类型、HLA相合程度、移植类型、预处理方案、急性移植物抗宿主病(aGVHD)、aGVHD程度、aGVHD累及器官等11项临床因素进行单因素分析,将有统计学意义的因素进行Logistic多因素同归分析,筛选出发生IPS的独立危险因素,并结合文献,探讨其发病机制.结果 192例allo-HSCT受者中,有23例发生IPS,发生时间为术后76 d(32～120 d),其中20例经治疗无效死亡,发病至死亡的时间为9 d(3～92 d),其余3例治愈.23例IPS患者中,有19例发生过aGVHD,其中肠道aGVHD16例.单因素分析显示,高危组、非亲缘供者、HLA不合、发生aGVHD、Ⅲ～Ⅳ度aGVHD及肠道aGVHD等6个因素具有统计学意义;多凶素分析显示,非亲缘供者、Ⅲ～Ⅳ度aGVHD和肠道aGVHD等3个因素是发生IPS的独立危险因素.结论 非亲缘供者、Ⅲ～Ⅳ度aGVHD及肠道aGVHD是发生IPS的独立危险因素;IPS可能是由aGVHD引起的肺部病变.

Clinical study of idiopathic pneumonia syndrome early after allogeneic hematopoietic stem cell transplantation

Objective To investigate the independent risk factors and the pathogenesis of idiopathic pneumonia syndrome (IPS) early following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods We retrospectively reviewed the clinical data of 192 patients undergoing allo-HSCT and analyzed the incidence and clinical manifestations of 23 cases of IPS.The 11 clinical parameters were selected for Logistic univariate analysis: age, gender, underlying disease, disease status at transplant, transplant type, conditioning regimens, donor type, aGVHD, severity of aGVHD, HLA disparity, organ involvement of aGVHD.Factors that were statistically significant on univariate analysis were evaluated by multivariate analysis using a Logistic regression.We explored the possible pathogenesis of IPS with review of the literature.Results Twenty-three of 192 patients developed IPS (12.0 %).Median time to IPS onset after allo-HSCT was 76 days (range 32～ 120 days), 20 patients with IPS died because of the rapid progression of respiratory failure (87.0 %), median time to death after the diagnosis of IPS was 9 days (range 3～92 days), and the remaining 3 patients were successfully treated by steroid; 19 patients with IPS developed aGVHD (82.6 %), with aGVHD of gut in 16 patients (69.6 %).The following 6 factors were associated with an increased risk of IPS by univariate analysis: not in remission, unrelated donor, HLA disparity, occurrence of aGVHD, grade Ⅲ～Ⅳ aGVHD, and aGVHD of gut.These risk factors were entered into a multivariate analysis model.Only unrelated donor, grade Ⅲ～ⅣaGVHD, and aGVHD of gut were identified as being significantly associated with the occurrence of IPS.Conclusion Patients were at increased risk of IPS if they had received graft from unrelated donor or developed grade Ⅲ～Ⅳ aGVHD, especially aGVHD of gut, suggesting that IPS possibly represents aGVHD involving the lung interstitium.