异基因造血干细胞移植患者发生口腔黏膜炎的危险因素分析_医学论文.docVIP

异基因造血干细胞移植患者发生口腔黏膜炎的危险因素分析_医学论文 异基因造血干细胞移植患者发生口腔黏膜炎的危险因素分析_医学论文 作者：童秀珍， 邹外一， 许多荣， 李娟， 罗绍凯， 彭爱华， 张国材， 郑冬【摘要】 【目的】 探讨进行异基因造血干细胞移植 (allo-HSCT)患者口腔黏膜炎 (OM)的发生及其危险因素。【方法】 回顾分析1996 年5月至2007 年3月在我院治疗的75 例恶性血液病患者allo-HSCT 的临床资料，分析相关因素与口腔黏膜炎发生的关系。【结果】 49例(65.0%)患者发生口腔黏膜炎，其中13 例(26.5%)发生Ⅲ度，14例(28.6%)发生Ⅳ度，中位发生时间移植后第5(3～8)天。单因素分析显示，患者年龄、疾病种类、移植方式与口腔黏膜炎的发生无相关性( P gt0. 05)，TBI/CY(全身照射+环磷酰胺)预处理的患者口腔黏膜炎发生率高于BU/CY(白消安+环磷酰胺)方案(78.3% vs 59.6%，P＜ 0.05)，口服剂型白消安口腔黏膜炎发生率高于静脉剂型(91.2% vs 11.1%，P＜ 0.001)，无四氢叶酸钙(CF)解救甲氨蝶呤(MTX)口腔黏膜炎明显高于CF解救(87.0% vs 9.5%， P＜ 0.001)。多因素回归分析结果表明，只有含TBI预处理方案(OR =3.6, P＜ 0.05)、口服剂型白消安 (OR =2.9, P＜ 0.01)、无CF解救MTX(OR =17.1, P＜ 0.001)是all-HSCT患者口腔黏膜炎发生的独立影响因素。【结论】 使用静脉剂型BU联合CY预处理方案、CF解救MTX的患者allo-HSCT后口腔黏膜炎发生率明显减少。 【关键词】 造血干细胞移植，异基因； 口腔黏膜炎； 危险因素 Abstract: 【Objective】 To investigate the incidence and risk factors of oral mucositis in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). 【Methods】 The clinical data of 75 patients with haematological malignancies undergoing allo-HSCT from May 1996 to March 2007 was analyzed, factors possibly correlated with the development of oral mucositis were assessed. 【Results】 Of the 75 patients,49 (65 %) developed oral mucositis , including 13 cases (26.5%) of grade Ⅲand 14 (28.6%) of grade Ⅳ oral mucositis. The mean time of onset was 5 days (range 3-8 days) after allo-HSCT. Univariate analysis showed that age, diagnosis of disease, stem cell source were not closely associated with the occurrence of oral mucositis (P gt0.05). The occurrence rate of oral mucositis was significantly higher in TBI/CY group than in BU/CY group (78.3% vs 59.6%，P＜ 0.05). The incidence of oral mucositis was significantly higher in the oral Bu group compared with intravenous Bu group (91.2% vs 11.1%, P＜ 0.001). The incidence of oral mucositis was significantly higher in lack of folinic acid rescue following MTX administration compared with folinic acid rescue (87.0% vs 9.5%, P＜ 0.001). In multiple regression analysis only TB