造血干细胞移植后早期急性肾损伤临床研究

发布时间：2018-06-02 15:22

  本文选题：造血干细胞移植 + 肾损伤　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：分析造血干细胞移植（hematopoietic stem cell transplantation，HSCT）后急性肾损伤（acute kidney injury，AKI）的发生率、危险因素、并探讨早期分子标志对急性肾损伤的预判意义。 方法： 1选择从2013-1至2014-2河北医科大学第二医院血液内科移植病房进行造血干细胞移植的14例患者。观察移植前年龄、性别、既往病史、移植前的基础肝功能、肾功能，移植的类型，预处理前肾毒性药物、移植的预处理方案、移植物抗宿主病（Graft versus host disease, GVHD）及预防方案、肝静脉闭塞病（hepatic veno-occlusive disease, HVOD）、骨髓及外周血干细胞的回输数量与移植后100d内急性肾损伤的关系。 2对入选的患者检测预处理前至移植后100d内运用苦味酸比色法测血肌酐水平，运用免疫比浊法测胱抑素C (cystatin-C, Cys C)的水平。运用ELISA方法检测尿肾损伤分子-1（kidney injury molecule-1, KIM-1）、中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil Gelatinase-AssociatedLipocalin. NGAL)、白介素-18（IL-18）水平，了解以上指标对AKI预判意义。AKI根据2005年国际AKI合作研讨会(The Acute Kidney InjuryNetwork，AKIN)制定的AKI的诊断标准及病情分级标准分为3期：1期，血肌酐升高≥0.3mg/dl，或血肌酐升高≥50％-200％；2期，血肌酐升高200％-300％；3期，血肌酐升高300％，或血肌酐4.0mg/d1(急性升高≥0.5mg/d1)。 结果： 110例（71%）患者发生AKI，其中自体造血干细胞移植患者1例（25%），，异基因造血干细胞移植患者9例发生AKI（90%）。AKI中位发生时间为+14天（0-26天）。 2环孢素毒性及巨细胞病毒（cytomegalovirus, CMV）、BK病毒（BKvirus，BKV）感染为发生AKI的危险因素。 3AKI组肌酐及KIM-1、CysC、NGAL、IL-18明显高于非AKI组。相关分析表明在AKI组，KIM-1、CysC、NGAL、IL-18与肌酐成正相关。ROC曲线证明CysC为0.745mg/L敏感度及特异度最高，分别为90%，99%。IL-18为19.68ng/L时灵敏度及特异度最高，分别为94%，99%。NGAL为1.079μg/L时灵敏度及特异度最高，分别为94%，99%。KIM-1为15.550ng/L时灵敏度及特异度最高，分别为96%，99%。 结论：AKI是造血干细胞移植后常见的并发症之一，环孢素毒性及CMV、BKV感染是AKI发生的危险因素。KIM-1、CysC、NGAL、IL-18可作为造血干细胞移植后患者发生AKI的诊断和肾功能的评估指标。
[Abstract]:Objective: to analyze the incidence and risk factors of acute renal injury after hematopoietic stem cell translocation after hematopoietic stem cell transplantation (hematopoietic stem cell transplantation), and to explore the predictive value of early molecular markers for acute renal injury. Methods: 1 14 patients with hematopoietic stem cell transplantation were selected for hematopoietic stem cell transplantation from the Department of Hematology, second Hospital of Hebei Medical University, 2013-1 to 2014-2. Age, sex, medical history, basic liver function, renal function, type of transplantation, preconditioning of nephrotoxic drugs, preconditioning regimen, graft versus host disease, GVHD) and prophylaxis were observed. The relationship between the number of hepatic veno-occlusive disease, bone marrow and peripheral blood stem cells and acute renal injury within 100 days after transplantation. 2 the serum creatinine levels were measured by picric acid colorimetry and cystatin C (Cys C) levels were measured by immunoturbidimetric method before preconditioning and 100 days after transplantation. ELISA was used to detect urinary kidney injury molecules-1 kidney injury molecule-1, KIM-1, neutrophil Gelatinase-associated lipocalin, and neutrophil Gelatinase-associated lipid carrier protein (neutrophil Gelatinase-associated Lipocalin). In order to understand the significance of the above indexes in the prediction of AKI. The diagnostic criteria and the grading criteria of the AKI according to the Acute Kidney InjuryNetwork AKIN (2005 International Symposium on AKI Cooperation) were divided into three stages: phase 1, the creatinine level 鈮

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