论文部分内容阅读
目的:分析异基因造血干细胞移植术(HSCT)后急性肾损伤(AKI)患者的临床资料、危险因素及预后,以提高HSCT患者AKI的早期诊疗水平,改善HSCT患者预后。方法:回顾性分析2010年1月至2012年12月于苏州大学附属第一医院血液科行HSCT的患者407例,观察移植前与移植后100d内肾功能变化,移植预处理方案及并发症,并随访观察1年。按AKI网络标准分为无AKI(NAKI)组和AKI组,通过Spearman相关性分析及Logistic回归分析筛选出AKI的危险因素。结果:407例患者中,NAKI组323例,发生AKI的患者84例(20.6%),其中AKIⅠ期59例,AKIⅡ期10例,AKIⅢ期15例。Logistic回归分析结果显示,人类白细胞抗原(HLA)不完全匹配、清髓性预处理、移植后并发症(败血症、肝静脉闭塞综合征)是HSCT后患者并发AKI的危险因素(P<0.05);1年后,107例(26.3%)HSCT患者死亡,其中NAKI组患者64例,AKIⅠ期患者26例,AKIⅡ期患者6例,AKIⅢ期患者11例,且死亡率随着AKI的严重程度逐渐增加。结论:AKI是HSCT后一种常见并发症,发生率为20.6%,HLA不完全匹配、清髓性预处理方式、移植后并发症(败血症、肝静脉闭塞综合征)是HSCT后患者发生AKI的危险因素。HSCT后并发AKI的患者死亡率显著高于NAKI患者,且1年的死亡率随着AKI的严重程度逐渐增加。
Objective: To analyze the clinical data, risk factors and prognosis of patients with acute kidney injury (AKI) after allogeneic hematopoietic stem cell transplantation (HSCT) to improve the early diagnosis and treatment of AKI in HSCT patients and to improve the prognosis of patients with HSCT. Methods: A total of 407 HSCT patients from Department of Hematology, First Affiliated Hospital of Soochow University from January 2010 to December 2012 were retrospectively analyzed. Changes of renal function, transplantation preconditioning protocol and complications before and after transplantation were observed. Follow-up observation for 1 year. According to the criteria of AKI network, there were no AKI (NAKI) group and AKI group. The risk factors of AKI were screened by Spearman correlation analysis and Logistic regression analysis. Results: Of the 407 patients, 323 were in the NAKI group and 84 (20.6%) were in the AKI group, of which 59 were in the AKI stage I, 10 in the AKI stage II, and 15 in the AKI stage III. Logistic regression analysis showed that the HLA - incompatibility, myeloablative preconditioning and posttransplant complications (sepsis and hepatic veno - occlusive syndrome) were risk factors of AKI complicated with HSCT (P <0.05). One year later, 107 (26.3%) HSCT patients died, including 64 in the NAKI group, 26 in the AKI stage I patients, 6 in the AKI stage II patients and 11 in the AKI stage III patients, with mortality increasing with the severity of AKI . Conclusion: AKI is a common complication after HSCT. The incidence of AKI is 20.6%. HLA is not completely matched. Myeloablative preconditioning and posttransplant complications (sepsis and hepatic veno-occlusive syndrome) are AKI patients after HSCT Risk factors. The mortality of patients with AKI after HSCT was significantly higher than that of patients with NAKI, and the 1-year mortality rate gradually increased with the severity of AKI.