闭塞性细支气管炎综合征(BOS)是造血干细胞移植(HSCT)后最常见的非感染性肺部并发症,该病通常起病隐匿,早期诊断困难,且病理改变不可逆,治疗效果差,导致显著的非复发性死亡率。目前关于儿童HSCT后BOS的研究有限,其临床诊疗仍然面临巨大挑战。本文将综述儿童HSCT后BOS的发病率、危险因素、发病机制、诊断标准及治疗进展,旨在为促进该疾病的早期诊断和有效治疗提供理论支持,推动临床实践的发展。Bronchiolitis obliterans syndrome (BOS) is the most common non-infectious pulmonary complication following hematopoietic stem cell transplantation (HSCT). The disease typically presents with an insidious onset, making early diagnosis challenging. Pathological changes are irreversible, treatment responses are poor, and it leads to significant non-relapse mortality. Currently, research on BOS in pediatric patients post-HSCT is limited, and clinical management remains a substantial challenge. This review summarizes the incidence, risk factors, pathogenesis, diagnostic criteria, and treatment advances of BOS following pediatric HSCT, aiming to provide theoretical support for early diagnosis and effective treatment of the disease, and to promote the advancement of clinical practice.
目的应用meta分析方法估算儿童造血干细胞移植(HSCT)后闭塞性细支气管炎综合征(BOS)的发病率,为术后患者的呼吸道随访管理提供科学依据。方法检索PubMed、Embase、Web of science、中华医学期刊全文数据库、万方数据、中国知网数据库,获取建库至2023年3月31日HSCT患儿术后BOS相关研究。对文献进行筛选、质量评价及信息提取,应用Stata 16.0软件进行分析。结果共纳入文献19篇,包含的总样本量为3955,共检出BOS 180例。经过meta分析得出HSCT术后患儿BOS的发病率为4%(95%CI:3%~5%),异质性为I^(2)=76.1%(P<0.01)。各研究之间的异质性通过研究人群所在不同地区、不同BOS诊断标准、研究样本量大小、单或多中心研究进行亚组分析来解释。敏感性分析显示结果是稳定的,但检测到发表偏倚。结论HSCT术后患儿BOS发病率为4%,但存在较大异质性,仍需要更多大型多中心研究来确定其发病率。儿科医师应对HSCT术后患儿进行科学管理和随访,以便早期诊治和及时发现BOS,提高患儿生存质量。
