温州地区终末期马兜铃酸肾病患者伴发肿瘤的研究  

Study on malignancy of end- stage aristolochic acid nephropathy patients in Wenzhou area

作　　者：孙梅[1] 章建娜[1] 刘毅[1] 徐玉兰[1] 林凡[1] 许菲菲[1] 

机构地区：[1]温州医科大学附属第一医院肾内科,325000

出　　处：《中华肾脏病杂志》2013年第10期731-736,共6页Chinese Journal of Nephrology

摘　　要：目的探讨因终末期马兜铃酸肾病（AAN）行肾脏替代治疗的患者发生肿瘤的情况。方法收集2004年至2013年诊断为终末期AAN并在本院接受替代治疗的患者共102例，研究肿瘤特点及相关因素。结果（1）伴发肿瘤患者共42例，占41．2％，39例（92．9％）为泌尿系肿瘤，其中8例发生转移，11例膀胱癌反复复发。肿瘤组患者病死率升高（13／42比7／60，P=0．022）。（2）其中13例患者在进入终末期肾病（ESRD）前即已发生肿瘤，另外29例患者在肾脏替代治疗后的1～13年【平均（4．62±3．31）年】相继发生肿瘤。（3）对29例进入肾脏替代治疗后发生肿瘤的患者进行logistic回归分析发现，肿瘤发病风险仅与马兜铃酸（aA）类药物剂量相关（P=0．091），相对木通剂量〈60g组，木通剂量〉200g组发病风险增加4．26倍（95％CI1．02，17．83）；而3种替代治疗方式的患者发生肿瘤的差异无统计学意义，但泌尿系肿瘤具体部位有所不同，其中血液透析患者单纯膀胱癌比例最高（72．72％），腹膜透析患者上尿路癌居多（66．67％），而移植患者复合性尿路癌比例相对较高（40．00％）。结论温州地区终末期AAN患者中，泌尿系肿瘤发生率高，且表现为复合、多发、复发等特点。肿瘤的发生与肾功能存在分离现象，且呈现较明显的剂量依赖性。不同肾脏替代治疗方式对AAN患者肿瘤的发生无明显影响，但可能导致肿瘤发病部位有所不同。Objective To investigate the features of malignancy in end- stage aristolochic acid nephropathy （AAN） patients undergoing renal replacement therapy in the First Affiliated Hospital of Wenhou Medical University. Methods One hundred and two patients diagnosed as end-stage AAN during 2004 to 2013 were enrolled in the study, and separately udergoing hemodialysis, peritoneal dialysis and renal transplantation, to study the features of the malignancy and its risk factors. Results （1） There were totally 42 AAN patients suffering from malignancy, and 39 of them had urinary cancer. Eight cases of urinary cancer had metastasis, and 11 cases of bladder cancer had repeated recurrences. Patients suffering from malignancy had an increased mortality compared to patients without malignancy （13/42 vs 7/60, P = 0.022）. （2） Thirteen malignacy cases were diagnosed before the end-stage of AAN, the rest cases appeared in 1-13 years[（4.62±3.31） years] after renal replacement. （3） A further logistic regression analysis of the 29 maligancy patients after renal replacement showed that, the dose of aristolochie acid （counted by Mutong） was the only risk factor of malignancy （1 = 0.091）, compared with the dose of Mutong less than 60 g, the patients with an accumulated dose of Mutong more than 200 g had a 4.26 folds （ 95%CI 1.02, 17.83 ） higher risk of malignancy. There was no statistic differenceof the malignancy risk among different renal replacement therapies, which however might influence the pathogenic sites of the urinary cancer. The simple bladder cancer was the most common malignancy among the hemodialysis patients （72.72%）, and the upper urinary tract cancer among the peritoneal dialysis patients （66.67%）, while the complex of both were dominant among the renal transplantation patients（40.00% ）. Conclusions Among the end- stage of AAN patients undergoing renal replacement therapy in Wenzhon area, the incidence of urinary cancer is high, with a character of complex, multiple and repeat

关 键 词：马兜铃酸 肿瘤 肾替代疗法 终末期肾病 

分 类 号：R692.5[医药卫生—泌尿科学]