儿童异基因造血干细胞移植后急性肾损伤临床分析

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

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)。按pRIFLE诊断标准将发生AKI的101例患儿分为风险期组54例、肾损伤期组31例以及肾衰竭期组16例。不同分期之间患儿Cr以及Ccr差异均有统计学意义(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<0.05)。结论儿童allo-HSCT发生AKI较为常见,aGVHD、SOS是AKI发生的危险因素;AKI与患儿1年OS相关。

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(P<0.05).According to pRIFLE diagnostic criteria,101 children with AKI were divided into the risk group(54 cases),the renal injury group(31 cases)and the renal failure group(16 cases).There were statistically significant differences in Cr and Ccr levels among different groups(P<0.05).The Cr level was higher and the Ccr level was lower in renal failure group.In the 1-year follow-up after allo-HSCT,18 children died,including 16 children with AKI(1 in risk group,5 in renal injury group and 10 in renal failure group).Survival analysis showed that the 1-year overall survival(OS)rate 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.