移植相关血栓性微血管病的危险因素及疗效分析

Transplantation-associated thrombotic microangiopathy： risk factors and treatment outcome

摘要

目的 研究移植相关血栓性微血管病（transplantation-associated thrombotic microangiopathy，TA-TMA）的临床特征、高危风险因素、治疗方案对TA-TMA的早期诊断以及治疗效果的价值。 方法 选择2019年1月至2023年6月在陆军军医大学第二附属医院血液病医学中心诊断的40例TA-TMA患者作为研究对象，同时选取同一时间段未发生TA-TMA异基因造血干细胞移植的患者120例，回顾性分析TA-TMA患者临床特征、高危风险因素、治疗反应、生存情况等。 结果 二元logistic回归分析结果显示单倍体移植、巨细胞病毒感染、急性移植物抗宿主病、钙调抑制剂浓度增高是TA-TMA发生的高危风险因素（P<0.05）；将40例TA-TMA患者的治疗方案分为2组：含血浆置换治疗方案26例（方案1），不含血浆置换治疗方案14例（方案2）。结果显示方案1存活8例（30.8%），方案2存活2例（14.3%），2组疗效差异无统计学意义（P>0.05）。 结论 单倍体造血干细胞移植、巨细胞病毒感染、急性移植物抗宿主病是TA-TMA发生的高危风险因素，本研究结果显示含或不含血浆置换方案疗效无显著统计学差异，建议依据患者病情、TA-TMA指南推荐进行治疗选择，后续亟需进一步探索更优的治疗方案，从而改善TA-TMA患者预后，提高患者生存率。

Abstract

Objective To investigate the effect of the clinical features，high-risk factors，and treatment regimens of transplantation-associated thrombotic microangiopathy（TA-TMA） on the early diagnosis and treatment outcome of TA-TMA. Methods A total of 40 patients with TA-TMA who were diagnosed in Hematology Medical Center，The Second Affiliated Hospital of Army Medical University，from January 2019 to June 2023 were enrolled as subjects，and 120 patients who did not experience TA-TMA after allogeneic hematopoietic stem cell transplantation during the same period of time were also enrolled. A retrospective analysis was performed for the clinical features，high-risk factors，treatment response，and survival status of TA-TMA patients. Results The binary logistic regression analysis showed that haploidentical transplantation，cytomegalovirus infection，acute graft-versus-host disease，and increased concentrations of calcium regulatory inhibitors were high-risk factors for TA-TMA（P<0.05）. According to the treatment regimen，40 patients with TA-TMA were divided into regimen 1 group with 26 patients（with the treatment regimen of plasma exchange） and regimen 2 group with 14 patients（without the treatment regimen of plasma exchange）. The results showed the survival of 8 patients in the regimen 1 group（30.8%） and 2 patients in the regimen 2 group（14.3%），and there was no significant difference in treatment outcome between the two groups（P>0.05）. Conclusion Haploidentical hematopoietic stem cell transplantation，cytomegalovirus infection，and acute graft-versus-host disease are high-risk factors for TA-TMA. The results of this study show no significant difference in treatment efficacy between the treatment regimens with or without plasma exchange. It is recommended to select treatment regimens according to the patient’s conditions and TA-TMA treatment guidelines，and it is urgent to further explore better treatment regimens to improve the prognosis and survival rate of TA-TMA patients.

关键词

造血干细胞移植 / 移植相关血栓性微血管病 / 危险因素 / 疗效

Key words

hematopoietic stem cell transplantation / transplanta-tion-associated thrombotic microangiopathy / risk factors / treatment outcome

基金资助

重庆市科卫联合医学科研项目面上资助项目(2023ZDXM022)