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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(HC),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 HC 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 HC 未缓解,死亡原因为其他移植相关并发症。结论出血性 HC 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。
Objective To analyze the etiology of delayed hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation. Methods A retrospective analysis of LOHC in 200 cases of allogeneic hematopoietic stem cell transplantation completed by Peking University Hematology Institute from 2004 to 2005 was retrospectively analyzed. Results A total of 57 out of 200 patients had hemorrhagic cystitis (HC), both of which were delayed. Etiological analysis showed that 31 cases of LOHC patients received complete antiretroviral therapy, the cause was attributed to infectivity, accounting for 54.39%; 12 cases of clinical viremia, after anti-virus treatment viremia disappeared, but no improvement in symptoms of cystitis , The cause of the disease was attributed to infection with non-infectious factors, accounting for 21.53%; another 14 cases of clinical evidence of non-infectious origin, of which 5 cases of alkalized diuretic cystitis alone was completely relieved, and the other 9 cases of anti-infective treatment ineffective The etiology attributed to non-infectious, accounting for 24.56%. Thirteen HC patients with noninfective factors were given short-term hormonal shock therapy, with nine patients achieving remission, two having partial remission, and two having no response. A total of 4 cases of various treatment ineffective, death HC did not ease, the cause of death for other transplant-related complications. Conclusion Hemorrhagic HC is a common complication after allogeneic hematopoietic stem cell transplantation. Clinic should pay attention to the identification of the causes of infection and non-infection, and the treatment of etiology can improve the curative effect.