以全身照射为预处理方案的急性白血病患者造血干细胞移植后间质性肺炎相关因素分析

摘要

Objective To analyze factors related to interstitial pneumonia (IP) in patients with acute leukemia after hematopoietic stem cell transplantation (HSCT) and had received total body irradiation (TBI) as conditioning regimen.Methods 139 cases with acute leukemia after HSCT with TBI as conditioning regimen were studied retrospectively. Univariate and multivariate analysis were conducted of clinical factors that may affect the occurrence of IP such as remission before transplantation, acute graft-versus-host disease, transplantation way, age, sex, and TBI program parameters such as irradiation scheme, dose rate and the whole body dose uniformity. Results Remission before transplantation (χ2=5.213,P=0.022), acute graft-versus-host disease (aGVHD) (χ2=5.829,P=0.016), irradiation scheme (χ2=4.281,P=0.039) were statistically signifi cant factors by univariate analysis; irradiation scheme (P=0.042), aGVHD (P=0.016), remission before transplantation (P=0.020) were signifi cantly correlated factors by Logistic regression model analysis.Conclusion Occurrence of IP after HSCT is the result of the combined effects of multiple factors. Great importance should be attached to the risk of IP in patients with non-fi rst complete remission, single total body irradiation and occurrence of aGVHD.%目的：分析预处理方案中含全身照射（total body irradiation, TBI）的急性白血病患者造血干细胞移植（hematopoietic stem cell transplantation, HSCT）后发生间质性肺炎（interstitial pneumonia, IP）的相关因素。方法对139例HSCT预处理方案中含TBI的急性白血病患者资料进行回顾性研究，对可能影响IP发生的临床因素如移植前缓解状态、急性移植物抗宿主病（acute graft-versus-host disease, aGVHD）、移植方式、年龄、性别以及TBI参数如照射方案、剂量率、全身剂量均匀度采用单因素和多因素分析。结果单因素分析差异有统计学意义的相关因素为移植前缓解状态（χ2=5.213， P=0.022）、aGVHD（χ2=5.829，P=0.016）、照射方案（χ2=4.281，P=0.039），Logistic回归模型多因素分析，照射方案（P=0.042）、aGVHD（P=0.016）、移植前缓解状态（P=0.020）为移植后IP发生的显著相关因素。结论 HSCT后发生IP是多因素综合影响的结果，对移植前非首次完全缓解（The first complete remission, CR1）、行单次TBI方案预处理以及发生aGVHD的患者要高度重视IP的风险。