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

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。AKIⅢ期患儿的1年生存率(28.6%±12.1%)低于NAKI (82.8%±5.2%)、AKIⅠ期(81.7%±7.4%)、AKIⅡ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。

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).Conclu sions 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.