CAJ | 학술논문

目的分析急性白血病患者异基因造血干细胞移植(allo-HSCT)后急性肾损伤(AKI)的发生率以及对预后的影响.方法回顾性分析66例急性白血病患者行清髓性allo-HSCT后的肾功能及相关临床数据.根据RIFLE分层诊断标准评价肾脏功能,分为:肾功能损伤危险(AKI-R)、肾功能损伤(AKI-I)和肾功能衰竭(AKI-F).结果 allo-HSCT后100 d内,有37例(56.1%)受者发生AKI,其中AKI-R 19例(28.8%),AKb-I11例(16.7%)和AKI-F 7例(10.6%);发生AKI的中位时间为allo-HSCT后29 d(1～89 d).与预处理前(基线)血肌酐水平比较,66例受者移植后21 d开始血肌酐水平显著增高(P＜0.05).移植后100 d时,发生肝脏静脉闭塞病(HVOD)的受者与未发生HVOD受者AKI-F发生率分别为(55.56±22.22)%和(9.01±4.75)%(P＜0.01);胆红素总量增高的受者与未增高的受者AKI-F发生率分别为(68.75±24.54)%和(8.38±4.17)%(P＜0.01);血环孢素A(CsA)浓度＞0.416μmol/L的受者与血CsA浓度较低的受者AKI的发生率分别为(66.67±10.29)%和(44.44±8.28)%(P＜0.05);无AKI、AKI-R、AKI-I和AKI-F的受者存活率分别为(89.66±5.66)%、(83.88±8.54)%、(81.82±11.63)%和(42.86±18.7)%,AKI-F组明显低于其他组(P＜0.05).结论 AKI是allo-HSCT后的常见并发症,不同程度的AKI对受者的存活率影响不同.应用RIFLE分层诊断标准对不同程度的肾功能损伤进行分级评价,可以早期诊断AKI并监测肾损伤的进展情况.
목적 분석급성백혈병환자이기인조혈간세포이식(allo-HSCT)후급성신손상(AKI)적발생솔이급대예후적영향.방법 회고성분석66례급성백혈병환자행청수성allo-HSCT후적신공능급상관림상수거.근거RIFLE분층진단표준평개신장공능,분위:신공능손상위험(AKI-R)、신공능손상(AKI-I)화신공능쇠갈(AKI-F).결과 allo-HSCT후100 d내,유37례(56.1%)수자발생AKI,기중AKI-R 19례(28.8%),AKb-I11례(16.7%)화AKI-F 7례(10.6%);발생AKI적중위시간위allo-HSCT후29 d(1～89 d).여예처리전(기선)혈기항수평비교,66례수자이식후21 d개시혈기항수평현저증고(P＜0.05).이식후100 d시,발생간장정맥폐새병(HVOD)적수자여미발생HVOD수자AKI-F발생솔분별위(55.56±22.22)%화(9.01±4.75)%(P＜0.01);담홍소총량증고적수자여미증고적수자AKI-F발생솔분별위(68.75±24.54)%화(8.38±4.17)%(P＜0.01);혈배포소A(CsA)농도＞0.416μmol/L적수자여혈CsA농도교저적수자AKI적발생솔분별위(66.67±10.29)%화(44.44±8.28)%(P＜0.05);무AKI、AKI-R、AKI-I화AKI-F적수자존활솔분별위(89.66±5.66)%、(83.88±8.54)%、(81.82±11.63)%화(42.86±18.7)%,AKI-F조명현저우기타조(P＜0.05).결론 AKI시allo-HSCT후적상견병발증,불동정도적AKI대수자적존활솔영향불동.응용RIFLE분층진단표준대불동정도적신공능손상진행분급평개,가이조기진단AKI병감측신손상적진전정황.
Objective To analyze morbidity and prognosis of acute kidney injury (AKI) in patients with acute leukemia after myeloablative allogenetic hematopoietic stem cell transplantation (HSCT).Methods Renal function and related clinical data in 66 patients receiving myeloablative alloHSCT were retrospectively analyzed.Renal function was evaluated by RIFLE criteria,which defines AKI as three grades of severity-risk (AKI-R),injury (AKI-I) and failure (AKI-F).Results Thirtyseven recipients (56.1%) developed AKI at a median of 29 days after allo-HSCT,including AKI-R(19 recipients,28.8 %),AKI-I (11 recipients,16.7 %),AKI-F (7 recipients,10.6 %).Compared with baseline value,serum creatinine level in the recipients was significantly increased at the 21st day after transplantation (P＜0.05).During 100 days after HSCT,the morbidity of AKI-F in recipients with HVOD and without HVOD were respectively (55.56 ± 22.22)% and (9.01 ± 4.75)% (P＜0.01).The morbidity of AKI in recipients with or without increased total bilirubin was respectively (68.75 ± 24.54)% and (8.38 ± 4.17)% (P＜0.01).The morbidity of AKI in recipients with or without increased CsA concentration was respectively (66.67 ± 10.29) % and (44.44 ± 8.28) % (P＜0.05).100-day survival rate in recipients after myeloablative allo-HSCT without AKI,with AKI-R,AKI-I and AKI-F was respectively (89.66 ± 5.66) %,(83.88 ± 8.54) %,(81.82 ± 11.63) % and (42.86 ± 18.7) % (P＜0.05).Conclusion AKI is one of the main complications in patients with acute leukemia after myeloablative allo-HSCT.The influence of different class AKI on the mortality was different.The earlier diagnosis,prophylaxis and treatment of AKI by the RIFLF criteria might increase the survival rate in recipients with HSCT.