乙型肝炎病毒血清学标志物异常对造血干细胞移植的影响

杜宏; 王玫; 杨栋林; 黄勇; 韩明哲

Abstract

杜宏,王玫,杨栋林,黄勇,韩明哲.乙型肝炎病毒血清学标志物异常对造血干细胞移植的影响[J].Chinese journal of Epidemiology,2008,29(4):387-391

乙型肝炎病毒血清学标志物异常对造血干细胞移植的影响

The effect of hepatitis B virus infection on the outcome of hematopoietic stem cell transplantation

Received:September 06, 2007

DOI：

KeyWord: 乙型肝炎病毒造血干细胞移植

English Key Word: Hepatitis B virus Hematopoietic stem eell transplantation

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Author Name	Affiliation	E-mail
DU Hong	Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
WANG Mei	Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
YANG Donglin	Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
HUANG Yong	Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China
HAN Mingzhe	Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China	mzhan@medmail.com.cn

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Abstract:

目的分析HBV感染对造血干细胞移植(HSCT)疗效及预后的影响.方法对2001-2006年279例HSCT患者及其中43例合并HBV血清学标志物异常患者的临床资料进行回顾性分析.结果 (1)HBV感染对造血干细胞的植入无明显影响.(2)HLA6位点相合异基因(allo)-HSCT中,HBV血清学标志物异常患者肝静脉闭塞症(HVOD)发生率(31.8%)、肝脏合并症发生率(72.7%)、致命性肝损害发生率(27.3%)均较正常组显著增高,差异有统计学意义(P值均＜0.05).(3)对HBV血清学标志物异常组有关肝脏的移植后疾病的危险因素进行单因素分析显示:肝脏合并症危险因素为allo-HSCT、原发疾病处于高危状态、移植前合并肝功能损害及以环孢菌素A(CsA)为移植物抗宿主病(GVHD)预防药物;HVOD危险因素为供者年龄＞25岁、移植前合并肝功能损害、原发疾病处于高危状态、预处理方案中含全身照射(TBI)、TBI腹部剂量＞7 Gy、以CsA为GVHD预防药物;致命性肝损害的危险因素为移植前合并肝功能损害和原发疾病处于高危状态.(4)HBV血清学标志物异常患者死亡率(51.2%)明显高于正常组患者死亡率(23.9%),主要死因以肝功能衰竭(LF)、多脏器功能衰竭(MOF)为主,且在免疫抑制剂减量过程中易出现肝功能恶化.(5)生存分析提示HBV血清学标志物异常组累积生存率显著降低(P=0.023).结论 HBV血清学标志物异常并非是HSCT的禁忌症,适当的移植时机、方案的选择,对危险因素的控制可有效的提高移植疗效,降低死亡率,提高生存质量。

English Abstract:

Objective To evaluate the effect of hepatitis B virus(HBV)infection on the outcome of hematopoietic stem cell transplantation(HSCT).Methods Among 279 patients with blood diseases underwent HSCT from 2001 to 2006, clinical data of 43 patients with HBV were analyzed retrospectively. Results (1)There was no significant difference in the engraftment of hematopoietic stern cells between HBV infected group and control group.(2)In all the HLA-matched allogeneic HSCTs,the incidence rates of hepatic veno-occlusive disease(HVOD)(31.8%),hepatic complications(72.7%)and fatal hepatic lesion (27.3%)were all significantly higher in HBV group than those in control group(P＜0.05).(3)Through univariate analysis.the risk factors of hepatic complications in HBV group were:pretransplant hepatic dysfunction:progression phase of primary disease;allo-HSCT;having used cyclosporine as graft-versus-host disease(GVHD)prophylaxis drug.Donor's age older than 25;pretransplant hepatic dysfunction;progression phase of primary disease;total body irradiation(TBI)conditioning regimen; TBI abdomen dosage was over 7 Gy etc.were the risk factors of HVOD.However,pretransplant hepatic dysfunction;progression phase of primary disease were among the risk factors causing fatal hepatic lesion.(4)The mortality rate in HBV group(51.2%)was significantly higher than that in the control group(23.9%).The major causes of death were multiple organ failure(MOF)and liver function failure(LF). Deterioration of LF was occurred in patients with allo-HSCT during immunosuppressive agent tapered off.(5)The accumulated survival rate in HBV group was significantly lower than that in the control group(P=0.023). Conclusion Donors and recipients infected with HBV were not contradictive to HSCT.The proper time of HSCT and suitable HSCT schedule could control Some of the transplantation risk factors and might be helpful in reducing the mortality rate and improving the quality of life through enhancing the curative effect.

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