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

Risk factors for acute kidney injury after hematopoietic stem cell transplantation in children: a retrospective study

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。

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.