Allo-HSCT患者术后环孢素A血药浓度与急性移植物抗宿主病的关系

摘要

Objective To analyze the relationship between cyclosporine A (CsA) concentration and acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods The clinical data of forty-six cases after allo-HSCT were retrospectively reviewed.The sex,age,weight,height and CsA concentration in different postoperative periods were compared respectively between aGVHD and no-aGVHD.The CsA concentration between grade Ⅰ ～ Ⅱ and Ⅲ ～Ⅳ aGVHD were compared.Results In the forty-six patients,39.13％ (18/46) occurred aGVHD.There was no significant difference in sex,age,weight and height between aGVHDand no-aGVHD.CsA levels were significantly different in the 1st,2nd,3rd,4th week and the 1st,2nd month after operation between aGVHD and no-aGVHD,which also had significant difference between grade Ⅰ ～ Ⅱ aGVHD and Ⅲ ～ Ⅳ aGVHD.Conclusion There is a strong relationship between CsA concentration within two months after operation and the incidence of aGVHD in allo-HSCT.%目的 研究异基因造血干细胞移植(allo-HSCT)患者环孢素A(CsA)血药浓度水平与急性移植物抗宿主病(aGVHD)的关系.方法 回顾性分析2007年1月至2011年12月期间广州医学院第一附属医院46例allo-HSCT患者术后的临床资料,分别比较术后aGVHD与无aGVHD患者的性别、年龄、体重、身高以及术后不同时段CsA血药浓度水平的差异,并且比较Ⅰ～Ⅱ级与Ⅲ～Ⅳ级aGVHD患者的CsA血药浓度水平差异.结果 39.13％ (18/46)的患者发生aGVH.aGVHD组与无aGVH组间患者的性别、年龄、体重、身高以及术后第三个月CsA血药浓度的差异均无统计学意义(P＞0.05);但两组患者术后第一、二、三、四周和第一、二个月CsA血药浓度的差异均有统计学意义(P＜0.05).I～Ⅱ级与Ⅲ～Ⅳ级aGVHD患者的CsA血药浓度差异有统计学意义(P＜0.05).结论 allo-HSCT患者aGVHD的发生与术后前两个月CsA血药浓度水平具有明显相关性.术后发生Ⅲ～Ⅳ级aGVHD患者的CsA血药浓度明显低于Ⅰ～Ⅱ级aGVHD的患者,说明低CsA血药浓度更易导致Ⅲ～Ⅳ级aGVHD的发生.