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目的 在异基因造血干细胞移植(allo-HSCT)后出现慢性移植物抗宿主病(cGVHD)的患者中,分析肺部受累的危险因素,判断患者移植前肺功能对cGVHD肺部受累有无预测作用.方法 回顾性分析2013年01月—2013年10月于苏州大学附属第一医院行allo-HSCT后出现cGVHD的患者,可评价病例共86例,其中cGVHD累及肺部者9例(观察组),未累及肺部者77例(对照组).通过比较两组的年龄、性别、诊断、吸烟史、既往患肺部疾病、移植前肺功能、供体来源及是否行全身放疗(TBI),来分析cGVHD累及肺部的危险因素,从而判断移植前肺功能对cGVHD肺部受累有无预测作用.结果 两组患者年龄、性别、诊断基本匹配,移植前每分钟最大通气量(MVV)与allo-HSCT患者cGVHD累及肺部相关(RR=3.869[95％CI 1.143～13.096],P=0.033).此外,尽管50％肺活量时的瞬间呼气流速(MEF50)、25％肺活量时的瞬间呼气流速(MEF25)、最大呼气中段流速(MMEF)占预计值的百分比均与cGVHD累及肺部无关(P>0.05),但三者结合所提示的小气道功能异常(三者中至少两者低于截值)与肺cGVHD相关(RR=4.722[95％CI 1.411～15.801],P=0.015).吸烟史、既往患肺部疾病、供体来源及其他常规肺功能检查指标在观察组及对照组间差异无统计学意义.对观察组和对照组患者进行随访(中位随访时间38个月)分析发现,存在肺部cGVHD、小气道功能异常或MVV功能异常者3年总生存率(OS)较低,3年非复发死亡率(NRM)较高,但差异无统计学意义.结论 移植前肺功能中的小气道功能及MVV异常是allo-HSCT患者cGVHD累及肺部的危险因素,移植前检测肺功能可有助于预测肺部cGVHD的发生.“,”Objective By identifying risk factors for pulmonary involvement among the patients who suffered from chronic graft- versu- host disease (cGVHD) post allogeneic hematopoietic stem cell transplantation (allo-HSCT) to evaluate the predicative role of pulmonary function for pulmonary involvement among the patients who had cGVHD. Methods A total of 86 patients with cGVHD post allo-HSCT from Jan. 2013 to Oct. 2013 in The First Affiliated Hospital of Soochow University. They were divided into pulmonary involvement (n=9) and non- pulmonary involvement (n=77) groups. Age, gender, diagnose, smoking history, previous lung disease history, pulmonary function before allo-HSCT, donor type and TBI were compared to identify risk factors for pulmonary involvement among the patients who suffered from cGVHD post allo-HSCT. Results Age, gender and diagnosis were matched. Maximum Ventilatory Volume (MVV) was relevant to pulmonary involvement among the patients who suffered from cGVHD post allo-HSCT (RR=3.869 [95％CI 1.143～13.096], P=0.033). Although forced expiratory flow after 50％ of the FVC has been exhaled (MEF50), forced expiratory flow after 25％ of the FVC has been exhaled (MEF25) and maximum midexpiratory flow (MMEF) were not relevant to pulmonary involvement (P>0.05), small airway dysfunction which means at least two of the MEF50, MEF25, MMEF were abnormal was relevant to pulmonary involvement among the patients who suffered from cGVHD post allo-HSCT (RR=4.722 [95％CI 1.411～15.801], P=0.015). Smoking history, previous lung disease history, other regularly pulmonary function before allo-HSCT, donor type and TBI showed no statistic difference between the two groups (P>0.05). The 3-year overall survival (OS) and 3-year Nonrecurrent mortality (NRM) showed no statistic difference between the two groups (P>0.05). Conclusion Small airway dysfunction and MVV abnormal may be the risk factors for pulmonary involvement among the patients who suffered from cGVHD post allo-HSCT. Pulmonary function testing (PFT) before allo-HSCT may predict the occurrence of pulmonary cGVHD.