本文選題：造血干細胞移植 + 腎損傷��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析造血干細胞移植（hematopoietic stem cell transplantation，HSCT）后急性腎損傷（acute kidney injury，AKI）的發(fā)生率、危險因素、并探討早期分子標(biāo)志對急性腎損傷的預(yù)判意義。 方法： 1選擇從2013-1至2014-2河北醫(yī)科大學(xué)第二醫(yī)院血液內(nèi)科移植病房進行造血干細胞移植的14例患者。觀察移植前年齡、性別、既往病史、移植前的基礎(chǔ)肝功能、腎功能，移植的類型，預(yù)處理前腎毒性藥物、移植的預(yù)處理方案、移植物抗宿主�。℅raft versus host disease, GVHD）及預(yù)防方案、肝靜脈閉塞�。╤epatic veno-occlusive disease, HVOD）、骨髓及外周血干細胞的回輸數(shù)量與移植后100d內(nèi)急性腎損傷的關(guān)系。 2對入選的患者檢測預(yù)處理前至移植后100d內(nèi)運用苦味酸比色法測血肌酐水平，運用免疫比濁法測胱抑素C (cystatin-C, Cys C)的水平。運用ELISA方法檢測尿腎損傷分子-1（kidney injury molecule-1, KIM-1）、中性粒細胞明膠酶相關(guān)脂質(zhì)運載蛋白(Neutrophil Gelatinase-AssociatedLipocalin. NGAL)、白介素-18（IL-18）水平，了解以上指標(biāo)對AKI預(yù)判意義。AKI根據(jù)2005年國際AKI合作研討會(The Acute Kidney InjuryNetwork，AKIN)制定的AKI的診斷標(biāo)準(zhǔn)及病情分級標(biāo)準(zhǔn)分為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)。 結(jié)果： 110例（71%）患者發(fā)生AKI，其中自體造血干細胞移植患者1例（25%），，異基因造血干細胞移植患者9例發(fā)生AKI（90%）。AKI中位發(fā)生時間為+14天（0-26天）。 2環(huán)孢素毒性及巨細胞病毒（cytomegalovirus, CMV）、BK病毒（BKvirus，BKV）感染為發(fā)生AKI的危險因素。 3AKI組肌酐及KIM-1、CysC、NGAL、IL-18明顯高于非AKI組。相關(guān)分析表明在AKI組，KIM-1、CysC、NGAL、IL-18與肌酐成正相關(guān)。ROC曲線證明CysC為0.745mg/L敏感度及特異度最高，分別為90%，99%。IL-18為19.68ng/L時靈敏度及特異度最高，分別為94%，99%。NGAL為1.079μg/L時靈敏度及特異度最高，分別為94%，99%。KIM-1為15.550ng/L時靈敏度及特異度最高，分別為96%，99%。 結(jié)論：AKI是造血干細胞移植后常見的并發(fā)癥之一，環(huán)孢素毒性及CMV、BKV感染是AKI發(fā)生的危險因素。KIM-1、CysC、NGAL、IL-18可作為造血干細胞移植后患者發(fā)生AKI的診斷和腎功能的評估指標(biāo)。
[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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