CAJ | 학술논문

目的探讨慢性粒细胞白血病清髓性异基因造血干细胞移植(HSCT)后急性肾损伤(AKI)的发生率和危险因素及其对患者移植后6个月生存率的影响.方法应用RIFLE标准对93例慢性粒细胞白血病患者清髓性异基因HSCT后肾脏功能的变化情况进行回顾性分析.结果清髓性异基因HSCT后100 d内有39例(41.9%)患者发生AKI,其中AKI危险(AKI.R)24例(25.8%),AKI损伤(AKI-I)10例(10.8%),AKI功能衰竭(AKI-F)5例(5.4%),中位时间为干细胞回输后40 d(1～96 d).移植后发生≥Ⅲ度急性移植物抗宿主病(aGVHD)患者与＜Ⅲ度aGVHD患者100 d内AKI发生率分别为(81.82±11.63)%和(36.59±5.32)%(P=0.0037).移植后出现总胆红素增高患者与无增高患者100 d内AKI发生率分别为(72.73±13.43)%和(37.04±5.37)%(P=0.0192).移植后发生≥Ⅲ度aGVHD是患者发生AKI的独立危险因素,其相对危险度(RR)为2.773195%可信区间(CI)(1.073～7.167),P=0.035];并且移植后发生≥Ⅲ度aGVHD患者发生AKI-I～和AKI-F的RR为6.320 [95%CI(1.464～27.291),P=0.013].移植后发生AKI患者100 d内病死率与无AKI患者差异有统计学意义(P:0.1301).移植后发生AKI-R、AKI-I和AKI-F的患者6个月的生存率分别为(86.96±7.02)%、(70.0±14.49)%和0(P=0.000).结论 AKI是慢性粒细胞门血病清髓性异基因HSCT后的重要并发症.移植后出现≥Ⅲ度aGVHD和总胆红素增高是发生AKI的影响因素.出现≥Ⅲ度aGVHD的患者易发生较重的AKI.移植后发生AKI程度越严重,患者6个月的生存率越低.RIFLE标准能提高早期诊断AKI的敏感性,并可监测肾功能进展情况,预测预后.
목적 탐토만성립세포백혈병청수성이기인조혈간세포이식(HSCT)후급성신손상(AKI)적발생솔화위험인소급기대환자이식후6개월생존솔적영향.방법 응용RIFLE표준대93례만성립세포백혈병환자청수성이기인HSCT후신장공능적변화정황진행회고성분석.결과 청수성이기인HSCT후100 d내유39례(41.9%)환자발생AKI,기중AKI위험(AKI.R)24례(25.8%),AKI손상(AKI-I)10례(10.8%),AKI공능쇠갈(AKI-F)5례(5.4%),중위시간위간세포회수후40 d(1～96 d).이식후발생≥Ⅲ도급성이식물항숙주병(aGVHD)환자여＜Ⅲ도aGVHD환자100 d내AKI발생솔분별위(81.82±11.63)%화(36.59±5.32)%(P=0.0037).이식후출현총담홍소증고환자여무증고환자100 d내AKI발생솔분별위(72.73±13.43)%화(37.04±5.37)%(P=0.0192).이식후발생≥Ⅲ도aGVHD시환자발생AKI적독립위험인소,기상대위험도(RR)위2.773195%가신구간(CI)(1.073～7.167),P=0.035];병차이식후발생≥Ⅲ도aGVHD환자발생AKI-I～화AKI-F적RR위6.320 [95%CI(1.464～27.291),P=0.013].이식후발생AKI환자100 d내병사솔여무AKI환자차이유통계학의의(P:0.1301).이식후발생AKI-R、AKI-I화AKI-F적환자6개월적생존솔분별위(86.96±7.02)%、(70.0±14.49)%화0(P=0.000).결론 AKI시만성립세포문혈병청수성이기인HSCT후적중요병발증.이식후출현≥Ⅲ도aGVHD화총담홍소증고시발생AKI적영향인소.출현≥Ⅲ도aGVHD적환자역발생교중적AKI.이식후발생AKI정도월엄중,환자6개월적생존솔월저.RIFLE표준능제고조기진단AKI적민감성,병가감측신공능진전정황,예측예후.
Objective To assess the incidence,risk factors and mortality of acute kidney injury(AKI)in patients with chronic myelogeneous leukemia(CML)after myeloablative allogenetic hematopoietic stem cell transplantation(HSCT). Methods Renal function in 93 CML patients undergone myeloablative allo-HSCT was retrospectively analyzed by the RIFLE criteria. Results Thirty-nine patients (41.9%) developed AKI at a median of 40 days after allo-HSCT, including 24 AKI-R patients(25.8%), 10 AKI-I patients(10.8%) and 5 AKI-F patients (5.4%). The morbidity of AKI in patients with ≥Ⅲ acute graft-versus-host disease (aGVHD) and without ＜Ⅲ GVHD was (81.82±11.63)% and (36.59±5.32)% (P=0.0037)rospectively. The morbidity of AKI in patients with increased total bilirubin and without increased total bilirubin was (72.73±13.43)% and (37.04±5.37)%(P=0.0192) respectively. ≥Ⅲ aGVHD was peor-prognostic factor of AKI and RR was 2.773 [95%CI (1.073-7.167), P=0.035]. RR of AKI-I and AKI-F in patients with ≥Ⅲ aGVHD was 6.320195%CI (1.464-27.291), P=0.013]. The mortality within 100 days after allo-HSCT of patients with AKI was significantly different as compared to patients without AKI (P=0.001). Six-mouth survival rates of different class AKI patients after myeloablative allo-HSCT were (86.96±7.02)% (AKI-R), (70.00±14.49)% (AKI-I), 0 (AKI-F) (P=0.000)respectively. Conclusions AKI is one of the main complications in CML patients after myeloablative allo-HSCT. ≥Ⅲ aGVHD and increased total bilimbin are poor-prognostic factors of AKI, and higher morbidity of AKI-I and AKI-F can be found in patients with ≥Ⅲ aGVHD. With the deteriorated AKI, 6-month survival is decreased. RIFLE criteria is sensitive to the early diagnosis of renal function. Moreover RIFLE can monitor the progression of AKI and predict the clinical outcome.