摘要目的 探讨清髓性异基因造血干细胞移植(allo-HSCT)后急性肾损伤(AKI)的发生率、发病机制、危险凶素及预防和治疗.方法 对120例清髓性allo-HSCT患者的临床资料进行回顾性分析.结果 清髓性allo-HSCT患者血清肌酐水平在移植后28～60d较基线水平明显增高(P＜0.05);73例(60.8%)患者发生不同程度的AKI,其中严重AKI(Ⅱ期)32例(26.7%),发生AKI中位时间为移植后33 d;Ⅰ期AKI患者环孢素A血药浓度明显增高(P＜0.05),肝静脉闭塞病(HVOD)、急性移植物抗宿主病(aGVHD)、总胆红素＞40 μmol/L是AKI发生的高危因素(P＜0.05);移植后100 d内死亡19例,Ⅱ期AKI是死亡的高危凶素(P＜0.05),移植后发生Ⅱ期AKI患者180 d的生存率明显降低(P＜0.05).结论 AKI是清髓性allo-HSCT后的重要并发症之一,预防并控制AKI可以降低移植后100 d的死亡率,提高移植早期患者的生存率.

abstractsObjective To explore the incidence,pathogenesis,risk factors,prophylasis and treat-ment of acute kidney injury(AKI)after myeloablative allogeneic hematopoietic stem eell transplantation(allo-HSCT).Methods Clinical data of 120 patients received myeloablative allo-HSCT were retrospectively ana’lyzed.Results Serum creatinine level in the patients showed significantly higher than baseline value at 28-60 days,fiter transplantation(P<0.05).73 patients(60.8％)developed AKI at a median of 33 days after allo-HSCT.including grade 2 in 32 patients(26.7％).Patients with grade 1 AKI showed significant higher serum cvclosporine A(CsA)levels(P<0.05).Hepatic veno-occlusive disease(HVOD),acute graft-versus-host disease(aGVHD)and total bilirubin>40 Ixmol/L were high risk factors of occurring AKI(P<0.05).19 Datients died within 100 days after allo-HSCT,grade 2 AKl was a high risk factor of mortality (P<0.05).180-dav survival rate Was significantly lower in patients with grade 2 AKI after allo-HSCT(P<0.05).Conclusion AKI is one of the major complications after myeloablative allo-HSCT.Prophylasis and treatment of AKI might reduce mortality in early stage of transplantation.