异基因造血干细胞移植患者发生口腔黏膜炎危险因素分析.docVIP

异基因造血干细胞移植患者发生口腔黏膜炎危险因素分析 　 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 gt;0. 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 gt;0.05). 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 TBI/CY conditioning regimen (RR =3.