异基因造血干细胞移植后迟发性出血性膀胱炎的临床分析

目的分析异基因造血干细胞移植后迟发性出血性膀胱炎（LOHC）的病因构成。方法对北京大学血液病研究所2004-2005年连续完成的200例异基因造血干细胞移植患者发生LOHC的情况进行回顾性的分析。结果200例移植患者中共有57例发生出血性膀胱炎（HE）,均为迟发性。病因分析显示：31例LOHC患者接受抗病毒治疗临床达到完全缓解,病因归结为感染性,占54．39％;12例临床合并病毒血症,经过抗病毒治疗病毒血症消失,但膀胱炎症状无好转,病因归结为感染性合并有非感染性因素,占21．53％;另有14例临床无感染原的证据,其中5例单靠碱化利尿膀胱炎即获完全缓解,另外9例对抗感染治疗无效,病因归结为非感染性,占24．56％。对有非感染性因素的13例HE患者给予短程的激素冲击治疗,9例达到缓解,2例达到部分缓解,2例无效。共有4例对各种治疗无效,死亡时HE未缓解,死亡原因为其他移植相关并发症。结论出血性HE是异基因造血干细胞细胞移植后常见的并发症,临床应重视对感染和非感染病因的鉴别,针对病因的治疗可以提高疗效。

Analysis of etiology of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

OBJECTIVE: To analyze the etiology and clinical features of late onset hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: The medical records of 200 patients undergoing allogeneic HSCT from 2004 to 2005 were analyzed retrospectively. RESULTS: HC developed in 57 patients within 180 days after the transplantation with a cumulative incidence of 28.8%. The etiology of 31 patients (54.39%) was infection, caused by infection of cytomegalovirus (CMV) or adenovirus and cured by anti-virus therapy, thus the cause of disease could be classified as infection agent. Viremia was seen in 12 patients (21.53%) with CMV and disappeared in urine after anti-virus therapy but bleeding still persisted. For these patients the cause of disease was classified as infection agent combined with non-infection factor. Evidence of infection agent could not be discovered in 14 patients (24.56%) and they failed to respond to anti-infection therapy. For them the cause of disease was classified as non-infection agent. 13 patients with refractory HC underwent tentative treatment with corticosteroids, 9 of them achieved a complete remission, 2 of them achieved partial remission, and 2 of them remained non-responsive. CONCLUSION: LOHC after allo-HSCT is a common complication and caused by multiple factors. Differentiation of the possible causes may benefit its clinical outcome.