异基因造血干细胞移植后迟发性非感染性肺部并发症的发生和危险因素分析

目的 分析异基因造血干细胞移植(allo-HSCT)后迟发性非感染性肺部并发症(LONIPC)的发生和危险因素.方法 回顾性分析我院2003年1月至2006年8月144例接受allo-HSCT并存活超过3个月的患者资料,统计LONIPC的发生率,分析其发生的危险因素.结果 144例患者中位随访时间为1149(103～2151)d,其中24例(16.7%)被诊断为LONIPC,发病中位时间为allo-HSCT后235(116～950)d.单因素分析结果显示,LONIPC的发生与巨细胞病毒(CMV)抗原血症(P＝0.000)、急性移植物抗宿主病(aGVHD)(P=0.026)、慢性移植物抗宿主病(cGVHD)(P=0.002)显著相关.多因素二分类Logistic回归分析结果显示,LONIPC发生的危险因素为cGVHD(OR=18.804,P=0.004)和CMV抗原血症(OR=14.376,P=0.000).结论 LONIPC是allo-HSCT晚期主要的并发症之一,eGVHD和CMV抗原血症是allo-HSCT后LONIPC发生的相关危险因素.

The incidence and risk factors of late-onset non-infectious pulmonary complications after allogeneic hematopoietic stem cell transplantation

Objective To analyze the incidence and the risk factors of late-onset non-infectious pulmonary complications ( LONIPC) after allogeneic hematopoietic stem cell transplantation ( allo-HSCT).Methods Clinical data from 144 patients who underwent allo-HSCT and survived more than 3 months at our institution between January 2003 and August 2006 were collected, and the incidence and its risk factors of LONIPC were reviewed retrospectively.Results With a median follow-up time of 1149 (103 -2151) d, 24 patients (16.7% ) fulfilled the diagnostic criteria for LONIPC.The median time to diagnosis of LONIPC was 235 days after transplantation (range, 116 -950 days).Three variables were associated with LONIPC on uni-variate analysis; CMV antigenaemia (P = 0.000) ,grade Ⅱ - Ⅳ aGVHD (P=0.026) and cGVHD (P = 0.002).By using a Binary Logistic regression model for multivariate analysis, cGVHD( OR = 18.804,P = 0.004) and CMV antigenaemia ( OR = 14.376,P =0.000) were the risk factors of LONIPC.Conclusion LONIPC is one of the major complications after allo-HSCT and cGVHD and CMV antigenaemia are the risk factors for developing LONIPC.