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目的探讨引起异体造血干细胞移植术后病人脑影像学结构异常的危险因素和发生率,并就其与病人生存率的相关性进行分析。方法回顾性分析了2004—2007年经异体造血干细胞移植术治疗病人的脑CT和(或)MR影像,这些病人均在接受治疗后1年内进行影像学检查。结果在治疗后1年间共有128例病人接受脑影像学检查。128例病人中的41例(32%)存在器质性病变,包括脑血管并发症(n=10)、中枢神经系统感染(n=9)、硬膜下积液(n=6)、复发于中枢神经系统的血液系统恶性肿瘤(n=11)及由药物毒性引起的其他异常(n=5)。研究发现引起脑器质性病变的唯一显著性危险因素是年龄,年龄越小危险性越高(P=0.01)。同时,MRI检查比CT检查对于病变的显示更具有优势,其差异具有统计学意义(P=0.001)。造血干细胞移植病人合并脑血管并发症时生存率明显减低(P<0.05)。然而,这41例存在脑器质性病变的病人与其他87例无脑器质性病变病人相比,总生存期不存在显著性差异。结论在是否存在脑器质性病变的病人间,其生存期无显著性差异;经造血干细胞移植治疗病人在合并脑血管并发症时将影响预后。
Objective To investigate the risk factors and the incidence of brain structural abnormalities in allogeneic hematopoietic stem cell transplantation patients and to analyze its correlation with patient survival rate. Methods A retrospective analysis of brain CT and / or MR images of allogeneic hematopoietic stem cell transplantation patients from 2004 to 2007 were performed and their images were examined within 1 year after treatment. Results A total of 128 patients underwent brain imaging in 1 year after treatment. There were organic lesions in 41 of 128 patients (32%), including cerebrovascular complications (n = 10), central nervous system infections (n = 9), subdural effusion (n = 6) Hematological malignancies in the central nervous system (n = 11) and other abnormalities caused by drug toxicity (n = 5). The study found that the only significant risk factor for organic brain disease was age. The younger the age, the higher the risk (P = 0.01). At the same time, the MRI examination showed more advantages than the CT examination on the pathological changes, the difference was statistically significant (P = 0.001). The survival rate of patients with hematopoietic stem cell transplantation combined with cerebrovascular complications was significantly decreased (P <0.05). However, there was no significant difference in overall survival between the 41 patients with organic brain disease and the other 87 patients without organic disease. Conclusion There is no significant difference in survival between patients with or without organic brain disease. Patients treated with hematopoietic stem cell transplantation will affect the prognosis in patients with cerebrovascular complications.