Epileptic seizures in patients following allogeneic hematopoietic stem cell transplantation: a retrospective analysis of incidence, risk factors, and survival rates
Epileptic seizures in patients following allogeneic hematopoietic stem cell transplantation: a retrospective analysis of incidence, risk factors, and survival rates
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DOI：
10.1111/ctr.12000
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发表时间：
2013
影响因子：
2.1
通讯作者：
Xiao-hui Zhang;Lanping Xu;Daihong Liu;Huan Chen;W. Han;Yu-Hong Chen;Feng‐rong Wang;Jing‐zhi Wang;Yu Wang;Ting Zhao;Yao Chen;H. Fu;Kai-yan Liu;Xiao-jun Huang
中科院分区：
文献类型：
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作者：
Xiao-hui Zhang;Lanping Xu;Daihong Liu;Huan Chen;W. Han;Yu-Hong Chen;Feng‐rong Wang;Jing‐zhi Wang;Yu Wang;Ting Zhao;Yao Chen;H. Fu;Kai-yan Liu;Xiao-jun Huang
异基因造血干细胞移植（allo-HSCT）患者中癫痫发作的发生率描述不多。目前还没有系统研究癫痫的可能原因、危险因素以及对异基因造血干细胞移植患者预后的影响的报道。我们回顾性研究了过去6.5年内在北京大学血液病研究所和人民医院接受allo-HSCT的1461例患者的数据。所有癫痫发作并发症的累积发生率为7.1%。在79例发生癫痫发作的移植患者中，3例（3.8%）在预处理阶段发生癫痫发作，52例（65.8%）发生在第0天至第100天，20例（25.3%）发生在第100天至第1年，4例（5.1%）发生在第1年后。多变量回归分析发现，受者年龄（≤18岁）（p < 0.001）、供体类型（p = 0.004）、移植物抗宿主病（aGVHD）（p = 0.018）和低钠血症（p = 0.003）是allo-HSCT患者癫痫发作的独立危险因素。移植后癫痫发作患者的中位生存时间为246 d（范围为18 ~ 2170 d）。与未发生癫痫发作并发症的患者相比，发生癫痫发作并发症的患者1年和6.5年后的生存率显著降低（1年时57.2% vs. 75.7%，p = 0.015，5年时31.1% vs. 71.4%，p < 0.001）。在79例发生癫痫发作并发症的患者中，53.2%死亡（n = 42）。这些患者的生存率相对较低，脑血管疾病或中枢神经系统感染相关的癫痫发作通常导致高死亡率和不良预后。患者移植年龄小于18岁、相关的不匹配移植、aGVHD和低钠血症是allo‐HSCT受者癫痫发作的风险因素。异基因HSCT患者的癫痫发作与预后不良相关。
The incidence of epileptic seizures among allogeneic hematopoietic stem cell transplant (allo‐HSCT) patients has been poorly described. No report has systematically studied epilepsy's possible causes, risk factors, and effect on prognosis among allo‐HSCT patients. We retrospectively examined data from 1461 patients who underwent allo‐HSCT within the past 6.5 yr at the Institute of Hematology and People's Hospital, Peking University. The cumulative incidence of all epileptic seizure complications was 7.1%. Of the 79 transplant patients who had epileptic seizures, 3 (3.8%) experienced a seizure during the conditioning stage, 52 (65.8%) between day 0 and day 100, 20 (25.3%) from day 100 to the first year, and 4 (5.1%) after the first year. Multivariate regression analysis identified the age of the recipient as (≤18 yr) (p < 0.001), donor type (p = 0.004), graft versus host disease (aGVHD) (p = 0.018), and hyponatremia (p = 0.003) as independent risk factors for epileptic seizures among allo‐HSCT patients. The median survival time of patients with epileptic seizures was 246 d after transplantation (ranging between 18 and 2170 d). Survival after one yr and 6.5 yr was significantly reduced in patients who developed epileptic seizure complications compared with those who did not (57.2% vs. 75.7% at one yr, p = 0.015, and 31.1% vs. 71.4% at five yr, p < 0.001). Of the 79 patients who experienced epileptic seizure complications, 53.2% died (n = 42). The survival rate of these patients was relatively low, and cerebrovascular disorders or central nervous system infection‐related epileptic seizures usually resulted in a high mortality and poor prognosis. A patient transplantation age which is younger than 18 yr, related mismatched transplants, aGVHD, and hyponatremia are risk factors for epileptic seizures in allo‐HSCT recipients. Epileptic seizures among allo‐HSCT patients are associated with a poor prognosis.