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目的:探讨异基因造血干细胞移植(Allo-HSCT)后癫痫并发症的病因、临床特点及高危因素。方法:回顾性分析148例Allo-HSCT患者癫痫发生情况及特点,并分析其病因及高危因素。结果:148例患者中,Allo-HSCT后1年内10例发生癫痫,发生率为6.8%,病死率高达60%(6/10)。癫痫发生的病因有药物、颅内出血、颅内感染、内环境紊乱和移植相关性血栓性微血管病(TMA)。癫痫发生率在HLA全相合与不全相合的患者中分别为3.2%(3/94)和13.0%(7/54)(P<0.05),在并发急性移植物抗宿主病(aGVHD)>Ⅱ度和≤Ⅱ度的患者中分别为21.1%(4/19)和4.7%(6/129)(P<0.05),在伴有或不伴高血压患者中分别为33.3%(7/21)和2.4%(3/127)(P<0.01)。结论:药物、颅内出血、颅内感染、内环境紊乱和TMA是Allo-HSCT后癫痫发生的常见病因,HLA不全相合、aGVHD和高血压是癫痫发生的高危因素。
Objective: To investigate the etiology, clinical features and risk factors of epilepsy complications after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). Methods: A retrospective analysis of 148 cases of Allo-HSCT in patients with epilepsy and characteristics, and analysis of its etiology and risk factors. Results: Of the 148 patients, epilepsy occurred in 10 cases within one year after Allo-HSCT with a rate of 6.8% and a mortality rate of 60% (6/10). The causes of epilepsy are drugs, intracranial hemorrhage, intracranial infection, endocrine disorders and transplant-associated thrombotic microangiopathy (TMA). The incidence of epilepsy was 3.2% (3/94) and 13.0% (7/54) respectively in patients with HLA-matched and incomplete HLA (P <0.05). In patients with acute graft-versus-host disease (aGVHD) And 21.1% (4/19) and 4.7% (6/129), respectively (P <0.05) in those with or without grade II and 33.3% (7/21) and 2.4% (3/127) (P <0.01). Conclusion: Drugs, intracranial hemorrhage, intracranial infection, internal environment disorders and TMA are common causes of epilepsy after Allo-HSCT. HLA incompetence, aGVHD and hypertension are risk factors for epilepsy.