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目的:本研究分析慢性髓系白血病(CML)异基因造血干细胞移植(allo-HSCT)患者移植早期急性心衰事件危险因素以及心衰患者的临床特点。方法:搜集南方医院血液科2003年5月至2013年5月CML allo-HSCT患者106例,依据移植早期(移植后100 d)患者有无发生急性心衰事件而分为心衰组(15例)和对照组(91例)。运用Logistic分析、Fisher确切概率法、Pearson X2检验等统计学方法分析急性心衰事件的危险因素及心衰组的临床特点。结果:CML allo-HSCT患者移植早期急性心衰事件发生中位时间为移植后3 d(移植前1 d-移植后84 d)。Logistic单因素分析显示,移植前格列卫治疗史、格列卫治疗时间及含抗胸腺细胞球蛋白(ATG)的GVHD预防方案为急性心衰事件的危险因素;心衰组肝静脉闭塞病(HVOD)、细菌感染及死亡等不良预后事件发生率都较对照组高(P<0.05)。结论:急性心衰事件多发在移植早期,移植前格列卫治疗及含ATG的GVHD预防方案是CML患者移植早期急性心衰事件的危险因素,心衰组患者常伴随较高的HVOD、细菌感染及不良预后事件发生率。
Objectives: This study was designed to analyze the risk factors of early acute heart failure and the clinical features of patients with heart failure in patients with chronic myelogenous leukemia (CML) allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: 106 patients with CML allo-HSCT were collected from Department of Hematology, Nanfang Hospital from May 2003 to May 2013. According to the patients with early heart failure (100 days after transplantation), the patients were divided into heart failure group (15 cases ) And control group (91 cases). Logistic analysis, Fisher exact test, Pearson X2 test and other statistical methods were used to analyze the risk factors of acute heart failure and the clinical features of heart failure group. Results: The median time to acute early heart failure in CML allo-HSCT patients was 3 days after transplantation (1 d before transplantation - 84 d after transplantation). Logistic univariate analysis showed that the treatment history of Gleevec, the treatment time of Gleevec and the prevention of GVHD with anti-thymocyte globulin (ATG) were the risk factors of acute heart failure before transplantation; hepatic veno-occlusive disease HVOD), bacterial infection and death and other adverse prognostic events were higher than the control group (P <0.05). CONCLUSIONS: Acute heart failure occurs frequently in early stage of transplantation. The treatment with Gleevec and ATG-containing GVHD prophylaxis before transplantation is a risk factor for early acute heart failure in CML patients. Patients with heart failure often have higher HVOD, bacterial infection And the incidence of adverse prognostic events.