Hypertension and Diabetes Mellitus in Adult and Pediatric Survivors of Allogeneic Hematopoietic Cell Transplantation
Hypertension and Diabetes Mellitus in Adult and Pediatric Survivors of Allogeneic Hematopoietic Cell Transplantation
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DOI：
10.1016/j.bbmt.2009.05.010
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发表时间：
2009-09-01
影响因子：
4.3
通讯作者：
Burns, Linda J.
中科院分区：
文献类型：
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作者：
Majhail, Navneet S.;Challa, Tejo R.;Burns, Linda J.
高血压和糖尿病是异基因造血细胞移植（HCT）常见的早期并发症;然而，其长期结局尚不清楚。我们进行了一项回顾性队列研究，以描述2003-2005年180例连续的成人（n = 106）和儿童（n = 74）异基因HCT接受者中HCT后高血压和糖尿病的风险因素和自然史，这些患者在HCT后存活了1年。儿童患者比成人患者更不可能患有HCT前高血压和糖尿病，吸烟史，或高风险疾病，更可能接受清髓性（MA）调节。所有患者随访至HCT后至少2年;在这些I年存活者中，156例（87%）在2年时存活。急性或慢性移植物抗宿主病（aGVHD，cGVHD）发生在118例（66%）患者中，其中24%接受环孢素（CsA）治疗> 12个月，47%接受泼尼松治疗> 12个月。HCT后2年内，126例（70%）患有高血压，54例（30%）患有糖尿病。成人受体（高血压，68%;糖尿病，30%）和儿科受体（高血压，73%;糖尿病，30%）的发生率相似。HCT后2年，在高血压患者中，34%的高血压未消退，在糖尿病患者中，32%的糖尿病未消退。在多变量分析中，暴露于CsA增加了HCT后发生高血压的风险（相对风险，1.6; 95%置信区间[CI]，1.1-2.5; P = 0.03），但不影响其2年后的持续性。暴露于高剂量皮质类固醇（累积泼尼松剂量> 0.25 mg/kg/d）增加了发生糖尿病的可能性（相对风险，3.6; 95% CI，1.7-7.5; P <0.01）和HCT后2年持续性糖尿病的可能性（相对风险，4.1; 95% CI，1.0-18.2; P = 0.05）。高血压和糖尿病是同种异体HCT的常见早期并发症，但随后在移植后的前2年内在大部分受者中消退。在同种异体HCT存活者中，特别是暴露于高剂量皮质类固醇的患者中，持续监测和治疗高血压和糖尿病是必要的。Biol Blood Marrow Transplant 15：1100-1107（2009）（C）2009年美国血液和骨髓移植学会
Hypertension and diabetes are frequent early complications of allogeneic hematopoietic cell transplantation (HCT); however, their long-term outcomes are not well known. We conducted a retrospective cohort study to describe the risk factors and natural history of post-HCT hypertension and diabetes in 180 consecutive adult (n = 106) and pediatric (n = 74) allogeneic HCT recipients from 2003-2005 who had survived for I year post-HCT The pediatric patients were less likely than the adult patients to have pre-HCT hypertension and diabetes, smoking history, or high-risk disease and more likely to receive myeloablative (MA) conditioning. All patients were followed until at least 2 years post-HCT; of these I-year survivors, 156 (87%) were alive at 2 years. Acute or chronic graft-versus-host disease (aGVHD, cGVHD) occurred in 118 (66%) patients; of these, 24% received cyclosporine (CsA) for > 12 months and 47% received prednisone for > 12 months. Within 2 years post-HCT, 126 (70%) had hypertension and 54 (30%) had diabetes. Rates were similar for the adult recipients (hypertension, 68%; diabetes, 30%) and the pediatric recipients (hypertension, 73%; diabetes, 30%). At 2 years post-HCT, in the patients with hypertension, hypertension had not resolved in 34%, and among patients with diabetes, diabetes had not resolved in 32%. On multivariate analyses, exposure to CsA increased the risk of developing hypertension post-HCT (relative risk, 1.6; 95% confidence interval [CI], 1.1-2.5; P = .03), but did not affect its persistence at 2 years. Exposure to high-dose corticosteroids (cumulative prednisone dose of > 0.25 mg/kg/day) increased the likelihood of developing diabetes (relative risk, 3.6; 95% CI, 1.7-7.5; P < .01) and for having persistent diabetes at 2 years post-HCT (relative risk, 4.1; 95% CI, 1.0-18.2; P = .05). Hypertension and diabetes are frequent early complications of allogeneic HCT but subsequently resolve in a large proportion of recipients in the first 2 years after transplantation. Continued monitoring and treatment of hypertension and diabetes is necessary in allogeneic HCT survivors, especially in those exposed to high doses of corticosteroids. Biol Blood Marrow Transplant 15: 1100-1107 (2009) (C) 2009 American Society for Blood and Marrow Transplantation