| Background and purposeHematopoietic stem cell transplantation is one of the most effective methods for the treatment of hematological tumors.With the continuous advancement of hematopoietic stem cell transplantation technology,many patients with hematological diseases have been relieved or cured,and the survival rate of patients with hematological tumors has Improved.Since hematopoietic stem cell transplant survivors have long-term survival after transplantation,survivors of hematopoietic stem cell transplantation may have complications associated with hematopoietic stem cell transplantation therapy.The complications not only affect the patient's life quality,but also become the important factors of late death of patients with hematopoietic stem cell transplantation[1].Compared with other complications,heart failure(HF)after hematopoietic stem cell transplantation is rare but severe with a poor prognosis[2].This study was designed to compare the clinical features and risk factors of patients with heart failure or non-heart failure after hematopoietic stem cell transplantation,and aim to improve the ability of early identification and intervention of patients with heart failure after hematopoietic stem cell transplantation and ameliorate patient's prognosisMethods(1)A total of 305 hospitalized patients with hematopoietic stem cell transplantation from January 2015 to December 2016.The patients were stratified by N termial B-type natriuretic peptide precursor(NT-proBNP)as elevated group(NT-proBNP>125),normal group(NT-proBNP<125),The data of two groups were retrospectively studied.The risk factors and clinical features of the two groups were compared.(2)According to the NT-proBNP and the heart failure symptoms,patients were divided into three groups,heart failure group(NT-proBNP>125 with heart failure symptoms),and no heart failure symptom group(NT-proBNP>125,but No heart failure symptoms),normal group(NT-proBNP<125 and no heart failure symptoms),a retrospective study of the three groups,comparing the prevalence of heart failure after hematopoietic stem cell transplantation and the clinical characteristics and risk factors of the three groups.Results(1)According to the results of NT-proBNP grouping,77.05%(235 cases)were elevated,and 22.95%(70 cases)were in normal group.In the elevated group,the female patients had more,hemoglobin and uric acid values were lower,and the NT-proBNP values were higher before transplantation(P<0.001).The 10/10-matching of HLA matching is more common in the normal group.The transplantation of bone marrow + peripheral blood stem cells is more common in the elevated group.The cyclophosphamide,cyclophosphamide + anthracycline,TBI+cyclophosphamide+ Anthracyclines were more common in the elevated group.The anti-rejection regimen was more common in the elevated group with cyclosporine + ATG.The pulmonary infection and symptoms of heart failure were more common in the elevated group.Age,systolic blood pressure,diastolic blood pressure,BMI,creatinine,blood sodium,eGFR,left ventricular ejection fraction,diastolic left ventricular diameter,left ventricular diameter,right ventricular diameter,left atrial diameter,right atrial diameter,diagnosis of blood diseases,There were no significant differences in the risk factors of cardiovascular disease(hypertension,diabetes),stem cell source,and creatine phosphate before transplantation(P>0.05).(2)According to the value of NT-proBNP and the presence or absence of heart failure symptoms,the heart failure group accounted for 23.6%(72 cases),the asymptomatic group accounted for 53.4%(163 cases),and the normal group accounted for 23%(70 cases).The prevalence of heart failure was 23.6%,of which male patients accounted for 55.6%(40 cases)and female patients accounted for 44.4%(32 cases).In patients with heart failure,the hemoglobin value was lower,the NT-proBNP value before transplantation was higher,the transplantation method of bone marrow + peripheral.blood hematopoietic stem cell transplantation,and the non-coherent matching type were more common in heart failure group,cyclophosphamide or anthracycline.The pretreatment regimen of combined cyclophosphamide,anti-thymocyte immunoglobulin(ATG)+ cyclosporine anti-rejection regimen was more common in the heart failure group,and the heart failure group was more common with pulmonary infection.Three groups in age,gender,systolic blood pressure,diastolic blood pressure,BMI,creatinine,blood sodium,eGFR,left ventricular ejection fraction,diastolic left ventricular diameter,left ventricular diameter,right ventricular diameter,left atrial diameter,right atrial diameter,The diagnosis of blood diseases,the source of stem cells,and the difference in the amount of creatine phosphate were not statistically significant among the three groups(P>0.05).Conclusions(1)The prevalence of heart failure after hematopoietic stem cell transplantation in this study was 23.6%.(2)In terms of pretreatment,drugs with small side effects should be selected.When anthracyclines and cyclophosphamide must be used,attention should be paid to the dynamic monitoring of cardiac function.(3)In terms of anti-graft-versus-host disease(GVHD),try to choose ATG as little as possible to avoid the side effects of ATG on the heart.(4)Patients with pulmonary infection after transplantation need to closely monitor cardiac function to avoid heart failure after hematopoietic stem cell transplantation. |
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