81例儿童造血干细胞移植后泌尿系损伤临床分析

发布时间：2018-10-22 08:42

【摘要】：目的探讨儿童造血干细胞移植后泌尿系损伤的病因、病理以及治疗和预后。方法回顾分析81例行造血干细胞移植患儿的临床资料,并复习相关文献。结果在81例患儿中,男50例、女31例,年龄8个月~17岁。肾前性损伤30例(37%),予积极补液等对症治疗后即恢复。肾性损伤9例(11.1%),其中4例放弃或转院,预后不详;其余5例行肾活检明确病理,经积极对症、对因治疗后,4例肌酐以及肾小球滤过率均恢复正常,但在长期随访中,1例因原发疾病复发、干细胞再输注合并肾衰竭死亡,其余3例进入慢性肾脏病;1例合并肾脏血栓性微血管病进入慢性透析。肾后性损伤包括出血性膀胱炎23例(28.4%)和泌尿道感染13例(16.0%),予大量补液、碱化尿液以及抗感染等治疗后,短期内多恢复,预后良好。结论造血干细胞移植后泌尿系损伤分为肾前性、肾性及肾后性,其中肾性损伤多复发。
[Abstract]:Objective to investigate the etiology, pathology, treatment and prognosis of urinary system injury after hematopoietic stem cell transplantation in children. Methods the clinical data of 81 children with hematopoietic stem cell transplantation were retrospectively analyzed and the related literatures were reviewed. Results there were 50 males and 31 females aged from 8 months to 17 years. Thirty cases (37%) of prerenal injury recovered after active fluid replacement therapy. Renal injury occurred in 9 cases (11.1%), of which 4 cases were abandoned or transferred to hospital, and the prognosis was unknown. Renal biopsy was confirmed in the remaining 5 cases. After active treatment, the creatinine and glomerular filtration rate returned to normal in 4 cases. But during the long term follow-up, one patient died of renal failure after primary disease recurrence, the other 3 patients with chronic renal disease and one patient with renal thrombotic microangiopathy, and one patient with renal thrombotic microangiopathy entered chronic dialysis. There were 23 cases of hemorrhagic cystitis (28.4%) and 13 cases of urinary tract infection (16.0%). Conclusion urinary system injury after hematopoietic stem cell transplantation can be divided into prerenal, renal and postrenal, among which renal injury recurs frequently.
【作者单位】：苏州大学附属儿童医院肾脏风湿免疫科;
【基金】：国家自然科学基金资助项目(No.81370787) 江苏省临床医学科技专项(No.SBL2014030237)
【分类号】：R726.9

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