【作者】 陈洁；

【导师】 朱康儿；

【作者基本信息】 暨南大学 ， 内科血液学， 2004， 硕士

【摘要】 目的 明确小剂量肝素预防以BU／CY为预处理方案的异基因造血干细胞移植后肝静脉阻塞症（VOD）的安全性和有效性，探讨小剂量肝素使用的最佳时间跨度。 方法 1997年4月至2004年3月，100例患者（男55例，女45例，中位年龄33岁）在本移植中心进行了异基因造血干细胞移植。所有病人均接受标准BU／CY或以此为基础的预处理方案，以肝素1001U·kg^-1·d^-1持续24小时静滴预防VOD。按移植前疾病不同分为白血病组94例，地中海贫血组6例。按移植类型将白血病组分为亲缘供者移植组67例和非亲缘供者移植组27例。按移植前肝功能正常与否分组，肝功正常组22例，肝功异常组78例。按肝素使用时间不同分为两组，一组为—7d至+21d，另一组则为—7d至+14d。早期15例进行凝血酶原时间（PT）和部分活化凝血活酶时间（APTT）监测，其后85例则未进行监测。 结果 100例患者中1例发生VOD（1％）。白血病组94例患者中无一例发生VOD（0％），其中27例为非亲缘供者移植；地贫组6例中1例发生重度VOD（16.7％）。肝功异常组22例中无一例发生VOD，肝功正常组则有1例地贫发生重度VOD死亡。使用肝素预防VOD时间跨度不同的两组均无VOD发生。未有定期检测PT、APTT组与监测组比较，临床出血情况并无明显加重。 结论 单一小剂量肝素100IU·kg^-1·d^-1预防以BU／CY为预处理方案的异基因造血干细胞移植后VOD安全有效。肝素使用时间跨度缩短为—7d至+14d并不影响其预防效果，且在肝素使用期问无需监测PT、APTT。更多还原

【Abstract】 Objective To explore the safety and efficacy of low dose heparin for the prevention of hepatic veno-occlusive disease (VOD) after allogeneic hematopoietic stem cell transplantation conditioned with busulfan and cyclophosphamide (BU-CY2) and the better time frame of the heparin administration.Methods From April 1997 to March 2004. 100 patients, including 94 leukemia patients and 6 thalessemia patients (55 male, 45 female; median age 33 years old), were transplanted in our BMT unit. All patients were conditioned with BU-CY2 or Busulfan - based regimen and scheduled to receive a continuous injection of heparin at a dose of 100IU kg-1-d-1. The patients were divided into different groups: leukemia group: 68 patients receiving related donor transplantation and 26 patients receiving unrelated donor transplantation, and thalassemia group: 6 patients; 22 patients with abnormal liver function prior to transplantation, and the other 78 patients with normal liver function; in the leukemia group, 40 patients received heparin from day -7 to day +21 post HSCT, and the other 50 patients from day -7 to day +14. In the early 15 patients prothrombin time (PT) and activated partial thromboplastin time (APTT) were monitored and in the other 85 patients PT and APTT were not. All bleeding episodes were recorded and graded.Results None of 94 leukemia patients developed VOD (0%). but one of the 6 thalassemia patients developed severe VOD (16.7%). And there were no statistically significant differences in the incidence of VOD both between abnormal liver function group and normal liver function group, and between the group of administering heparin from day -7 to day +14 and that from day -7 to day +21. The incidence and severity of clinical bleeding events in 15 patients with monitoring of PT and APTT is comparable with those without monitoring of PT and APTT.Conclusion These results suggest that low dose heparin alone is effective and safe for the prophylaxis of VOD following allogeneic hematopoietic stem cell transplantation conditioned with BU-CY regimen. Shortening the duration of administering heparin from -7d to +21d to -7d to +14d does not affect the effectiveness of low dose heparin to prevent VOD.更多还原