异基因造血干细胞移植后女性的性与生殖健康结局研究

Sexual and Reproductive Health Outcomes in Women after Allogeneic Hematopoietic Stem Cell Transplantation

摘要: 目的：性功能障碍与生育力丧失是女性异基因造血干细胞移植(allo-HSCT)后最常见且严重的并发症，严重影响患者生存质量。本研究基于真实世界数据，评估allo-HSCT后早发性卵巢功能不全(POI)患者的临床症状、性功能、生育结局及其相关临床因素。方法：本研究为单中心横断面研究，纳入2012年4月~2023年4月期间于我院接受allo-HSCT的女性患者56例，收集allo-HSCT后3年内与血液疾病、月经和生育有关的数据并进行分析。结果：56例患者移植中位年龄26.8岁，POI发生率为78.6% (44/56)。单因素分析显示，POI发生与移植年龄、预处理方案及原发病类型相关。围绝经期症状普遍存在，移植时年龄较小者临床症状较轻。42.9%患者报告移植对于性生活存在影响，单因素分析提示性生活影响程度与是否发生cGVHD有关(P = 0.041)。月经自发恢复率仅为15.6% (7/45)，仅2例患者移植后妊娠并生产，其中1例接受了卵巢组织冻存移植(OTC)治疗作为生育力保护措施。结论：allo-HSCT后POI患者面临严重的临床症状、性功能障碍及生育力丧失，目前临床对移植后女性内分泌管理及性健康的关注仍显不足。亟需加强对造血干细胞移植后女性生殖健康问题的认识与干预，以改善其远期生存质量。

Abstract: Objective: Sexual dysfunction and fertility loss are among the most common and severe complications in female patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT), significantly impacting their quality of life. This study aimed to evaluate the clinical symptoms, sexual function, fertility outcomes, and related clinical factors in patients with premature ovarian insufficiency (POI) following allo-HSCT based on real-world data. Methods: This single-center cross-sectional study enrolled 56 female patients who underwent allo-HSCT at our hospital between April 2012 and April 2023. Data regarding hematologic conditions, menstruation, and fertility within three years post-transplantation were collected and analyzed. Results: The median age of the 56 patients was 26.8 years. The incidence of POI was 78.6% (44/56). Univariate analysis showed that POI was associated with age at transplantation, conditioning regimen, and primary disease type. Perimenopausal symptoms were prevalent, with milder symptoms observed in patients who were younger at the time of transplantation. Among the patients, 42.9% reported that transplantation had an impact on their sexual life, and univariate analysis indicated that the degree of this impact was associated with the occurrence of chronic graft-versus-host disease (cGVHD) (P = 0.041). The spontaneous menstrual recovery rate was only 15.6% (7/45). Only two patients achieved pregnancy and delivery post-transplantation, one of whom underwent ovarian tissue cryopreservation and transplantation (OTC) as a fertility preservation measure. Conclusion: Patients with POI after allo-HSCT face severe clinical symptoms, sexual dysfunction, and fertility loss. Current clinical attention to endocrine management and sexual health in post-transplant women remains insufficient. There is an urgent need to enhance awareness and intervention regarding reproductive health issues in female patients after hematopoietic stem cell transplantation to improve their long-term quality of life.