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    异基因造血干细胞移植后继发性血小板减少患者的危险因素及预后意义分析

    Analysis of the risk factors and prognosis of patients with secondary thrombocytopenia after allogeneic hematopoietic stem cell transplantation

    • 摘要: 目的 探讨异基因造血干细胞移植(allo-HSCT)后继发性血小板减少的危险因素及其预后意义。方法 选取2013年1月—2020年6月于徐州医科大学附属医院接受allo-HSCT的患者,共264例,收集临床资料进行回顾性分析。根据患者移植后+60 d血小板计数(PLT),分为血小板减少组(PLT<30×109/L)和对照组(PLT≥30×109/L),分析血小板减少的危险因素及预后意义。结果 与对照组相比,血小板减少组的巨细胞病毒(CMV)感染率显著增高(P=0.002)。多因素分析显示CMV感染为继发性血小板减少的独立危险因素。血小板减少组1年及3年总生存率(OS)与无疾病生存率(DFS)均显著低于对照组,血小板减少组1年及3年非复发死亡率(NRM)均高于对照组,差异有统计学意义(P<0.001)。多因素分析显示,+60 d PLT<30×109/L是影响OS率、DFS率及NRM率的独立危险因素(P<0.001)。结论 CMV感染与移植后继发性血小板减少相关,发生继发性血小板减少的患者预后不良。

       

      Abstract: Objective To investigate the risk factors and prognosis of secondary thrombocytopenia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods A total of 264 patients who received allo-HSCT in the Affiliated Hospital of Xuzhou Medical University from January 2013 to June 2020 were selected and their clinical data were retrospectively analyzed. According to the platelet count (PLT) of +60 days after transplantation, the patients were divided into two groups: a thrombocytopenia group (PLT<30×109/L) and a control group (PLT≥30×109/L). The risk factors and prognosis of thrombocytopenia were analyzed. Results The thrombocytopenia group showed a significantly higher infection rate of cytomegalovirus (CMV) than the control group (P=0.002). According to multivariate analysis, CMV infection was an independent risk factor for secondary thrombocytopenia. The 1-year and 3-year overall survival (OS) rate and disease-free survival (DFS) rate in the thrombocytopenia group were remarkably lower than those in the control group, while the 1-year and 3-year non-relapse mortality (NRM) in the thrombocytopenia group was higher than that in the control group (P<0.001). Multivariate analysis showed that +60 d PLT<30×109/L was an independent risk factor affecting OS rate, DFS rate and NRM rate (P<0.001). Conclusions CMV infection is associated with secondary thrombocytopenia after allo-HSCT, and the prognosis of patients with secondary thrombocytopenia is poor.

       

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