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

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 ...

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

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.