儿童造血干细胞移植后急性肾损伤相关危险因素的回顾性研究

doi:10.7499/j.issn.1008-8830.2205007

摘要
图/表
参考文献(17)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (636 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的探讨造血干细胞移植（hematopoietic stem cell transplantation，HSCT）后急性肾损伤（acute kidney injury，AKI）的危险因素。方法回顾性研究2018年1月至2020年1月111例行HSCT患儿的临床资料。采用多因素logistic回归分析筛选出AKI发生的影响因素；采用Kaplan-Meier生存分析比较不同级别AKI患儿生存预后差异。结果 111例HSCT患儿中，AKI发生率为52.3%（58/111）。移植物抗宿主病（Ⅱ~Ⅳ度）（OR=4.406，95%CI：1.501~12.933，P=0.007）、肝小静脉闭塞综合征（OR=4.190，95%CI：1.191~14.740，P=0.026）、血栓性微血管病（OR=10.441，95%CI：1.148~94.995，P=0.037）与HSCT患儿移植后AKI发生密切相关。AKI Ⅲ期患儿的1年生存率（28.6%±12.1%）低于NAKI（82.8%±5.2%）、AKI Ⅰ期（81.7%±7.4%）、AKI Ⅱ期（68.8%±11.6%）患儿（P<0.05）。结论患儿HSCT后发生Ⅲ期AKI具有较高的病死率；移植物抗宿主病、肝小静脉闭塞综合征、血栓性微血管病与HSCT后AKI发生密切相关。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘健
	陈志伟
	王英洁
	买钰淼
	胡会会
	任兵
	王颖超
	刘玉峰

关键词 ：造血干细胞移植, 急性肾损伤, 影响因素, 患儿

Abstract：Objective To investigate the risk factors for acute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) in children. Methods A retrospective analysis was performed on the medical data of 111 children who underwent HSCT from January 2018 to January 2020. A multivariate logistic regression analysis was used to identify the risk factors for AKI. The Kaplan-Meier survival analysis was used to compare the prognosis in children with different grades of AKI. Results Graft-versus-host disease (grade Ⅱ-Ⅳ) (OR=4.406, 95%CI: 1.501-12.933, P=0.007), hepatic veno-occlusive disease (OR=4.190, 95%CI: 1.191-14.740, P=0.026), and thrombotic microangiopathy (OR=10.441, 95%CI: 1.148-94.995, P=0.037) were closely associated with the development of AKI after HSCT. The children with stage Ⅲ AKI had a lower 1-year survival rate than those without AKI or with stage Ⅰ AKI or stage Ⅱ AKI (28.6%±12.1% vs 82.8%±5.2%/81.7%±7.4%/68.8%±11.6%; P<0.05). Conclusions Children with stage Ⅲ AKI after HSCT have a higher mortality rate. Graft-versus-host disease, hepatic veno-occlusive disease, and thrombotic microangiopathy are closely associated with the development of AKI after HSCT.

Key words： Hematopoietic stem cell transplantation Acute kidney injury Risk factor Child

收稿日期: 2022-05-03

作者简介: 刘健，男，博士，副教授。Email：93624638@qq.com；

引用本文:

刘健,陈志伟,王英洁等. 儿童造血干细胞移植后急性肾损伤相关危险因素的回顾性研究[J]. 中国当代儿科杂志, 2022, 24(10): 1136-1142.

LIU Jian,CHEN Zhi-Wei,WANG Ying-Jie et al. Risk factors for acute kidney injury after hematopoietic stem cell transplantation in children: a retrospective study[J]. CJCP, 2022, 24(10): 1136-1142.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2205007 或 http://www.zgddek.com/CN/Y2022/V24/I10/1136

	Bazinet A, Popradi G. A general practitioner's guide to hematopoietic stem-cell transplantation[J]. Curr Oncol, 2019, 26(3): 187-191. PMID: 31285665. PMCID: PMC6588058. DOI: 10.3747/co.26.5033.
	Abramson MH, Gutgarts V, Zheng J, et al. Acute kidney injury in the modern era of allogeneic hematopoietic stem cell transplantation[J]. Clin J Am Soc Nephrol, 2021, 16(9): 1318-1327. PMID: 34135023. PMCID: PMC8729581. DOI: 10.2215/CJN.19801220.
	3 伏苡铭, 戴春. 造血干细胞移植后急性肾损伤的相关分析[J]. 临床血液学杂志, 2021, 34(7): 483-488. DOI: 10.13201/j.issn.1004-2806.2021.07.007.
	Krishnappa V, Gupta M, Manu G, et al. Acute kidney injury in hematopoietic stem cell transplantation: a review[J]. Int J Nephrol, 2016, 2016: 5163789. PMID: 27885340. PMCID: PMC5112319. DOI: 10.1155/2016/5163789.
	Sakaguchi M, Nakayama K, Yamaguchi H, et al. Risk factors for acute kidney injury and chronic kidney disease following allogeneic hematopoietic stem cell transplantation for hematopoietic malignancies[J]. Acta Haematol, 2020, 143(5): 452-464. PMID: 31822013. DOI: 10.1159/000504354.
	Andronesi AG, Tanase AD, Sorohan BM, et al. Incidence and risk factors for acute kidney injury following autologous stem cell transplantation for multiple myeloma[J]. Cancer Med, 2019, 8(6): 3278-3285. PMID: 31016881. PMCID: PMC6558584. DOI: 10.1002/cam4.2187.
	中华医学会血液学分会干细胞应用学组. 中国异基因造血干细胞移植治疗血液系统疾病专家共识(Ⅰ)——适应证、预处理方案及供者选择(2014年版)[J]. 中华血液学杂志, 2014, 35(8): 775-780. PMID: 25152138. DOI: 10.3760/cma.j.issn.0253-2727.2014.08.029.
	8 聂应明, 刘婧, 戚畅, 等. 儿童异基因造血干细胞移植后急性肾损伤临床分析[J]. 临床儿科杂志, 2022, 40(1): 21-26. DOI: 10.12372/jcp.2022.21e0892.
	中华医学会血液学分会干细胞应用学组. 中国异基因造血干细胞移植治疗血液系统疾病专家共识(Ⅲ)——急性移植物抗宿主病(2020年版)[J]. 中华血液学杂志, 2020, 41(7): 529-536. PMID: 32549120. PMCID: PMC7449769. DOI: 10.3760/cma.j.issn.0253-2727.2020.07.001.
	10 急性肾损伤专家共识小组. 急性肾损伤诊断与分类专家共识[J]. 中华肾脏病杂志, 2006, 22(11): 661-663. DOI: 10.3760/j.issn:1001-7097.2006.11.005.
	Kanduri SR, Cheungpasitporn W, Thongprayoon C, et al. Incidence and mortality of acute kidney injury in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis[J]. QJM, 2020, 113(9): 621-632. PMID: 32101318. PMCID: PMC7828586. DOI: 10.1093/qjmed/hcaa072.
	Koh KN, Sunkara A, Kang G, et al. Acute kidney injury in pediatric patients receiving allogeneic hematopoietic cell transplantation: incidence, risk factors, and outcomes[J]. Biol Blood Marrow Transplant, 2018, 24(4): 758-764. PMID: 29196074. DOI: 10.1016/j.bbmt.2017.11.021.
	Wanchoo R, Stotter BR, Bayer RL, et al. Acute kidney injury in hematopoietic stem cell transplantation[J]. Curr Opin Crit Care, 2019, 25(6): 531-538. PMID: 31524721. DOI: 10.1097/MCC.0000000000000657.
	Raina R, Herrera N, Krishnappa V, et al. Hematopoietic stem cell transplantation and acute kidney injury in children: a comprehensive review[J]. Pediatr Transplant, 2017, 21(4): e12935. PMID: 28485097. DOI: 10.1111/petr.12935.
	15 周丽君, 乔青, 李明, 等. 异基因造血干细胞移植后患者急性肾损伤的危险因素及预后分析[J]. 肾脏病与透析肾移植杂志, 2016, 25(2): 119-123. DOI: 10.3969/cndt.j.issn.1006-298X.2016.02.004.
	Deger SM, Erten Y, Suyani E, et al. Early diagnostic markers for detection of acute kidney injury in allogeneic hematopoietic stem cell transplant recipients[J]. Exp Clin Transplant, 2020, 18(1): 98-105. PMID: 28411358. DOI: 10.6002/ect.2016.0161.
	Mii A, Shimizu A, Kaneko T, et al. Renal thrombotic microangiopathy associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation[J]. Pathol Int, 2011, 61(9): 518-527. PMID: 21884301. DOI: 10.1111/j.1440-1827.2011.02704.x.