临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (1): 21-.doi: 10.12372/jcp.2022.21e0892

• 血液/ 肿瘤疾病专栏 • 上一篇    下一篇

儿童异基因造血干细胞移植后急性肾损伤临床分析

聂应明 1, 刘婧 2, 戚畅 3, 王卓 1, 陈智 1, 杨李 1, 卢文婕 1, 唐威 1, 祁闪闪 1, 熊昊 1   

  1. 华中科技大学同济医学院附属武汉儿童医院 1.血液肿瘤科,2 .心血管内科,3 .肾脏内科 (湖北武汉 430016)
  • 出版日期:2022-01-15 发布日期:2022-01-11
  • 通讯作者: 熊昊 电子信箱:22587481 @qq.com
  • 基金资助:
    湖北省卫生和计划生育委员会基金项目(No.WJ 2017 M 195);湖北省科技厅基金项目(No. 2012 FFB 05302); 湖北省自然科学基金项目(No. 2020 CFB 364)

Clinical analysis of acute kidney injury after allogeneic hematopoietic stem cell transplantation in children

NIE Yingming1 , LIU Jing2 , QI Chang3 , WANG Zhuo1 , CHEN Zhi1 , YANG Li1 , LU Wenjie1 , TANG Wei1 , QI Shanshan1 , XIONG Hao1   

  1. 1.Department of Pediatric Hematology and Oncology, 2.Department of Cardiology, 3.Department of Nephrology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, Hubei, China
  • Online:2022-01-15 Published:2022-01-11

摘要: 目的 分析儿童异基因造血干细胞移植(allo-HSCT)后急性肾损伤(AKI)的临床特征及危险因素。 方法 回顾性分析2016年8月至2020年3月于武汉儿童医院血液肿瘤科接受allo-HSCT患儿的临床资料,对比移植 预处理开始前及移植后100天血肌酐(Cr)、肌酐清除率(Ccr),以及移植后1年的生存情况;采用logistic回归分析影 响AKI发生的危险因素。结果 共147例allo-HSCT患儿纳入研究,其中男85例、女62例,接受移植时中位年龄5.5岁 (0.7个月~ 16岁)。其中101例(68.7%)患儿发生AKI,中位时间为移植后24.0(-5.0~91.0)d。二元logistic回归分 析显示,移植后急性移植物抗宿主病(aGVHD)、肝窦间隙阻塞综合征(SOS)是AKI发生的独立危险因素(P<0.05),肾衰竭期组Cr较高,Ccr较低。allo-HSCT后随访1年,18例患儿 死亡,其中AKI患儿死亡16例(风险期1例,肾损伤期5例,肾衰竭期10例)。生存分析发现无AKI组1年总体生存(OS) 率为(95.70±2 . 97)%,AKI组为(84.00±3 . 86)%,两组间差异有统计学意义(P

关键词: 异基因造血干细胞移植; 急性肾损伤; 儿童

Abstract: Objective To analyze the clinical characteristics and risk factors of acute kidney injury (AKI) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. Methods The clinical data of children who received allo-HSCT in the Department of Hematology and Oncology, Wuhan Children's Hospital from August 2016 to March 2020 were retrospectively analyzed. Serum creatinine level (Cr) and creatinine clearance rate (Ccr) before and 100 days after transplantation were compared, and survival rate 1 year after transplantation was analyzed. The risk factors of AKI were analyzed by logistic regression. Results A total of 147 children ( 85 boys and 62 girls) with allo-HSCT were included in the study, with a median age of 5 . 5 years ( 0 . 7 months to 16 years) at the time of transplantation. AKI occurred in 101 patients ( 68 . 7 %) with a median time of 24 . 0 (- 5 . 0 - 91 . 0 ) days after transplantation. Binary logistic regression analysis showed that acute graft-versus-host disease (aGVHD) and sinusoidal obstruction syndrome (SOS) were independent risk factors for AKI after transplantation (Prate was ( 95 . 70 ±2 . 97 ) % in the non-AKI group and ( 84 . 00 ±3 . 86 ) % in the AKI group, and the difference between the two groups was statistically significant (P<0 . 05 ). Conclusions AKI is common in children with allo-HSCT, and aGVHD and SOS were the risk factors for AKI. AKI was associated with 1-year OS.

Key words: allogeneic hematopoietic stem cell transplantation; acute kidney injury; child