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目的分析小儿造血干细胞移植(HSCT)后出血性膀胱炎(HC)的临床特点,探讨其发病危险因素。方法对1998年10月至2004年6月中山大学附属二院儿科完成的52例小儿HSCT后11例HC的临床资料进行回顾分析。结果11例HC中轻度(Ⅰ～Ⅱ度)6例,重度(Ⅲ～Ⅳ度)5例;早发性4例,迟发性7例;发病时间为术后+2d至+25d(中位数为+15d),病程3～60d(中位数为17d)。临床表现均有血尿,其中典型尿频、尿急、尿痛及肉眼血尿7例。HC患儿组中性粒细胞植入时间和血小板植入时间与非HC患儿组比较差异无显著性(P>0.05)。受者移植年龄≥6岁、aGVHD阳性、CMV感染组的HC发生率分别高于年龄<6岁(32.1%和8.3%,P<0.05)、GVHD阴性(34.6%和7.7%,P<0.05)、CMV未感染组(62.5%和13.6%,P<0.05)。结论小儿HSCT后HC有其自身的临床特征;受者移植年龄≥6岁、aGVHD阳性、CMV感染为其发生的危险因素。

Hemorrhagic cystitis after hematopoietic stem cell transplantation in children :clinical characteristics and risk factors

??Abstract Objective To study the clinical characteristics and risk factors of hemorrhagic cystitis (HC) in children after hematopoietic stem cell transplantation.Methods The clinical records of HC in 11 of 52 pediatric patients who underwent umbilical cord blood transplantation (UCBT) and peripheral blood stem cell transplantation (PBSCT) were analyzed retrospectively.Results HC with a median onset time of day +15 (range day+2~+25) was classified as early in 4 cases,late in 7 cases,and graded as mild to moderate in 6 cases,severe in 5 cases.Of all the patients,11/11 had hematuria and 7/11 had typical pollakisuria,urgent micturition,odynuria and gross hematuria.There were no significant differences between the patients with HC and patients with no??HC in the recovery time of ANC??0.5??10⁹/L and PLT??20??10⁹/L.However,the incidence of HC was much higher in the group of ??6 years old,positive group of acute graft??versus??host disease (aGVHD) and group of cytomegalovirus (CMV) infection than that in group of <6 years old (32.14% vs 8??33%,P<0.05),negative group of aGVHD(34.62% vs 7.69%,P<0.05)and group of CMV no??infection(62.50% vs 13.64%,P<0.05)respectively.All patients recovered in a median 12.8 days(range 2~53 days).Conclusion HC in children after HSCT has its own clinical characteristics.The risk factors of HC include older age (??6 years),aGVHD positive and CMV infection.