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目的探讨异基因外周造血干细胞移植(allo-HSCT)患者骨髓空窗期血小板输注影响因素及其相关性。方法利用自主开发的临床用血管理与评价信息系统检索并搜集到2014年1月-2016年12月在本院血液内科诊断为allo-HSCT的153例病例,根据病例纳入的排除标准纳入其中90例病例资料为回顾性分析对象,以allo-HSCT患者骨髓空窗期平均血小板输注量作为阈值分为输注血小板≥6个治疗量的观察组38例和输注血小板<6个冶疗量的对照组52例,比较2组骨髓空窗期血小板输注量、预处理前患者Hb、ANC、Plt、SF、血小板植活时间、植入的单个核细胞数等临床观察指标,并作Logistic回归分析。结果 1)2组间性别、年龄、原发病、供受者HLA配型、预处理前Hb、植入的单个核细胞数均较为相近(P>0.05);预处理前ANC(×10~9/L)为1.24±0.57 vs 3.36±1.33、Plt(×10~9/L)为43.55±68.29 vs 1 26.62±84.73、SF(μg/L)为2 351.05±1 587.96 vs 1 000.96±362.97、供受者ABO血型配型不合(例)为15 vs 10、血小板植活时间(d)为16.84±2.47 vs 12.73±1.65、骨髓空窗期血小板输注量(治疗量)为8.37±1.50 vs 3.63±1.12(P<0.05)。2)Logistic单因素回归分析:预处理前ANC、Plt、SF、供受者ABO血型配型、血小板植活时间,2组存在明显差异(P<0.05),为allo-HSCT骨髓空窗期血小板输注的影响因素;多因素回归分析:预处理前ANC、PLT植活时间2组存在明显差异(P<0.05)。结论预处理前ANC和血小板植活时间是allo-HSCT患者骨髓空窗期血小板输注的独立影响因素。其中血小板植活时间为独立危险因素,其越长预示血小板输注需求量越大;预处理前ANC为独立保护因素,其越大预示血小板输注量则越小。
Objective To investigate the influential factors and their relationship of platelet transfusion in patients with allo-HSCT during allogeneic peripheral blood stem cell transplantation. Methods A total of 153 cases diagnosed as allo-HSCT in our Department of Hematology from January 2014 to December 2016 were collected and searched by the self-developed clinical blood management and evaluation information system. According to the exclusion criteria included in the cases, 90 Case data were retrospectively analyzed. Thoracic and fenestrated platelet transfusions in allo-HSCT patients were divided into three groups: 38 patients in the observation group receiving ≥ 6 therapeutic doses of platelets and 6 patients in the treatment group receiving transfusion of platelets Control group of 52 cases, comparing the two groups of bone marrow empty-phase platelet transfusion, pre-treatment patients with Hb, ANC, Plt, SF, platelet activation time, the number of implanted mononuclear cells and other clinical indicators, and Logistic regression analysis. Results 1) The gender, age, primary disease, HLA matching of donor, pre-treatment Hb, number of mononuclear cells implanted were similar between the two groups (P> 0.05) L was 1.24 ± 0.57 vs 3.36 ± 1.33, Plt (× 10 ~ 9 / L) was 43.55 ± 68.29 vs 1 26.62 ± 84.73, SF (μg / L) was 2 351.05 ± 1 587.96 vs 1 000.96 ± 362.97, The donor ABO blood type mismatch (case) was 15 vs 10, platelet live time (d) was 16.84 ± 2.47 vs 12.73 ± 1.65, bone marrow emptying phase platelet transfusion volume (treatment) was 8.37 ± 1.50 vs 3.63 ± 1.12 (P <0.05). (2) Logistic regression analysis: There was a significant difference (P <0.05) between pre-treatment ANC, Plt, SF, donor ABO blood grouping and platelet activation time, Factors influencing infusion were analyzed by multivariate regression analysis. There were significant differences in ANP and PLT survival time between the two groups before pretreatment (P <0.05). Conclusions ANC and platelet activation time before preconditioning are independent factors influencing bone marrow empty cell platelet transfusion in allo-HSCT patients. The platelet activation time was an independent risk factor. The longer it predicted the greater the demand for platelet transfusion; the pre-treatment ANC as an independent protective factor, the greater the predicted platelet transfusion less.