造血干细胞移植后心衰患者临床特征及危险因素分析

目的 探讨造血干细胞移植后心衰患者临床特征及危险因素,提高造血干细胞移植后心衰的早期识别和早期干预,改善患者预后.方法 选取上海交通大学医学院附属瑞金医院2017年7月—2019年7月骨髓及外周造血干细胞移植患者200例纳入研究,依据患者术后1个月N末端B利钠肽前体值(NT-proBNP)及心衰症状分为心衰组(患者有心...

Clinical characteristics and risk factors of heart failure patients after hematopoietic stem cell transplantation treatment

  Objective  To explore the clinical characteristics and risk factors of patient with heart failure after haematopoietic stem cell transplantation(HSCT), improve methods for the early recognition and intervention for patients with heart failure after haematopoietic stem cell transplantation and improve the prognoses of patients.  Methods  From July 2017 to July 2019, a total of 200 cases of bone marrow and peripheral blood stem cell transplantation were obtained. On the basis of the N terminal value of b-type natriuretic peptide precursor (NT-proBNP) and heart failure symptoms, patients were divided into the heart failure group (patients with symptoms of heart failure and the NT-proBNP>125 pg/mL) and heart failure group, and clinical features and possible risk factors of the patients in the two groups were compared.  Results  The incidence rate of heart failure after HSCT was 22.50%. The haematopoietic stem cell transplantation group before transplantation in patients with heart failure in the aftermath of the NT-proBNP value, pulmonary infection, cord blood combined rate of peripheral blood haematopoietic stem cell transplantation, not in all matches, whether for recurrence of the pretreatment of refractory, cyclophosphamide or anthracycline-based combined with cyclophosphamide solution rate and spore. The anti-thymocyte immunoglobulin+ring anti-rejection scheme selection rate was higher, and haemoglobin value of the haematopoietic stem cell transplantation group was lower than those of the heart failure group, the difference statistically significant (all P < 0.05); Logistic regression analysis showed a high NT-proBNP value before transplantation and high NT-proBNP value one month after transplantation, combined with pulmonary infection and umbilical cord blood combined with haematopoietic stem cell transplantation were independent risk factors for heart failure after hematopoietic stem cell transplantation (OR=1.184, 1.154, 1.091, 0.217).  Conclusion  High NT-proBNP value before transplantation, high NT-proBNP value one month after transplantation, combined with pulmonary infection and umbilical cord blood combined with peripheral blood haematopoietic stem cell transplantation are independent risk factors for heart failure after haematopoietic stem cell transplantation. Special attention should be given to such patients in clinical practice for early intervention, reduction of the risk of heart failure and improvement of prognosis.