Abstract



BACKGROUND: Hemorrhagic cystitis (HC) is one of common complications in patients undergoing hematopoietic stem cell transplantation (HSCT). It is of great value for improvement in the HSCT outcome to describe the clinical characteristics of HC and risk factors.
OBJECTIVE: To investigate the incidence of HC in children after HSCT, and to analyze its clinical characteristics and risk factors.
DESIGN: Case analysis
SETTING: Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics, Second Affiliated Hospital of Sun Yat-sen University.
PARTICIPANTS: Experiments were performed at the Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics of Second Affiliated Hospital of Sun Yat-sen University from October 1998 to June 2004. Eighty-eight patients receiving umbilical cord blood transplantation (UCBT) and peripheral blood stem cell transplantation (PBSCT) were enrolled; 49 were males and 39 were females. The age ranged from 2 to 18 years with an average of 8.0 years. Guardians of child patients signed informed consents. The experimental procedures were approved by Medical Ethics Committee.
METHODS: ①Conditioning regimens included combination of cyclophosphamide (CY, 120-200 mg/kg) with busulphan (BU, 14-20 mg/kg)-based chemotherapy and combination of CY with total body irradiation (TBI, 2-8 Gy) or total lymphoid irradiation (TLI, 2-8 Gy)-based radiotherapy. ②HC was defined according to the criteria proposed by references 7 and 8. The incidence, clinical characteristics, laboratory examination, treatment and outcome for HC were described. The association of various clinical factors including age, gender, human leucocyte antigen (HLA) typing, diseases for transplant, the type of stem cell, the type of transplantation, the occurrence of acute graft-versus-host disease (aGVHD) and cytomegalovirus (CMV) infection with the development of HC were examined.
MAIN OUTCOME MEASURES: ①Incidence of HC, ②HC patient characteristics and laboratory examination, ③HC treatment and outcome, and ④risk factors analysis.
RESULTS: All 88 patients were included in the final analysis. ①The incidence of HC: 16 patients (18.2%, 16/88) developed HC post-transplant with the severity graded as mild in 11 cases (68.7%) and severe in 5 cases (31.3%). ②HC patient characteristics and laboratory examination: All had hematuria and 8 cases (50.0%) had typical pollakisuria, urinary urgency, odynuria and gross hematuria; 10 cases (62.5%) had gross hematuria and 11 had proteinuria (+ to +++); Leucocytes were detected in 7 cases. ③Treatment and outcome: All patients recovered at a median of 13.5 days (range 2-53 days). ④Risk factors analysis: The incidence of HC was significantly higher in the group of ≥ 6 years old, presence of aGVHD and development of cytomegalo-virus (CMV) infection (P < 0.05-0.01).
CONCLUSION: ①HC has its own clinical characteristics following HSCT in children but with good prognosis. ②The risk factors for HC are ≥ 6 years old, presence of aGVHD and CMV infection.

Department of Pediatrics, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China

Xu Hong-gui☆, Studying for doctorate, Attending physician, Department of Pediatrics, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
gzxhg@126.com

Correspondence to: Fang Jian-pei, Doctor, Professor, Tutor of doctor, Department of Pediatrics, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
Jpfang2005@
163.com

Received:2007-09-19
Accepted:2008-01-16
(07-50-9-5143/YWY)

Xu HG, Fang JP, Huang SL, Zhou DH, Chen C, Huang K, Li Y.Hemorrhagic cystitis in children undergoing hematopoietic stem cell transplantation: Clinical characteristics and risk factors.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(8):
1596-1600(China)

[www.zglckf.com/
zglckf/ ejournal/
upfiles/08-8/
8k-1596(ps).pdf]

儿童造血干细胞移植后出血性膀胱炎：临床特征与危险因素☆

摘要
背景：出血性膀胱炎是造血干细胞移植后常见并发症之一，探讨其临床特征及发病的危险因素对改善造血干细胞移植效果有重要应用意义。
目的：观察小儿造血干细胞移植后出血性膀胱炎发病情况，并分析其临床特点以及发病危险因素。
设计：病例分析。
单位：中山大学附属第二医院儿科造血干细胞移植中心。
对象：选择1998-10/2004-06在中山大学附属第二医院儿科HSCT中心88例接受脐血移植与外周血造血干细胞移植患儿，男49例，女39例，年龄2~18岁，平均8.0岁。 所有患儿家属对治疗知情同意。实验经过医院伦理委员会批准许可。
方法：①患儿预处理方案主要有环磷酰胺（120~200 mg/kg）和马利兰（Bu，14~20 mg/kg）组成为主的化疗方案，以及环磷酰胺联合全淋巴照射（2-8Gy）或全身照射（2-8Gy）组成的放疗方案。②按文献[7]及[8]标准诊断及对出血性膀胱炎分类；观察患者出血性膀胱炎发生率、临床特征、实验室检查及治疗与转归；分析年龄、性别、供受者人类白细胞抗原配型、移植病种、移植类型、移植方式、急性移植物抗宿主病的发生、巨细胞病毒感染对出血性膀胱炎发生的影响。
主要观察指标：①患儿出血性膀胱炎发生率。②临床特征与实验室检查。③治疗与转归。④出血性膀胱炎发生的危险因素。
结果：纳入患儿88例均进入结果分析。①出血性膀胱炎发生率：16例（18.2%，16/88）患儿发生出血性膀胱炎，其中轻度11例（68.7%），重度5例。②临床特征与实验室检查：患儿均有血尿，其中典型尿频、尿急、尿痛及肉眼血尿8例（50.0%）；肉眼血尿10例（62.5%）；11例蛋白尿（＋~＋＋＋），7例白细胞增高。③治疗与转归：所有出血性膀胱炎患儿均痊愈，病程2~53 d。④出血性膀胱炎发生危险因素：受者移植年龄≥6岁、急性移植物抗宿主病阳性及巨细胞病毒感染出血性膀胱炎发生率分别高于年龄＜6岁、GVHD阴性及巨细胞病毒未感染患儿，差异有统计学意义（P < 0.05~0.01）。
结论：①儿童造血干细胞移植后出血性膀胱炎有其自身的临床特征，预后多良好。②受者移植年龄≥6岁、急性移植物抗宿主病阳性、巨细胞病毒感染可能为其发生的危险因素。
关键词：出血性膀胱炎；造血干细胞移植；危险因素；临床特征；儿童

徐宏贵，方建培，黄绍良，周敦华，陈 纯，黄 科，黎 阳
中山大学附属第二医院儿科， 广东省广州市 510120
徐宏贵☆，男，1972年生，安徽省东至县人，汉族，中山大学在读博士，主治医师，主要从事小儿血液病及造血干细胞移植的实验与临床研究。
通讯作者：方建培，博士，教授，博士生导师，中山大学附属第二医院儿科，广东省广州市 510120



中图分类号: R394.2 文献标识码: A 文章编号: 1673-8225(2008)08-01596-05
徐宏贵，方建培，黄绍良，周敦华，陈纯，黄科，黎阳.儿童造血干细胞移植后出血性膀胱炎：临床特征与危险因素[J].中国组织工程研究与临床康复，2008，12(8):1596-1600
[www.zglckf.com/zglckf/ejournal/upfiles/08-8/8k-1596(ps).pdf]
（Edited by Jong-Beom Park/Qiu Y/Wang L）