高截留量透析在骨髓瘤管型肾病引起的严重急性肾损伤中的应用  

Application of high cut-off dialysis for severe acute kidney injury secondary to cast nephropathy in patients with multiple myeloma

作　　者：李静晶[1] 张文君[1] 唐亚 赵鹏鸣 LI Jing-jing;ZHANG Wen-jun;TANG Ya;ZHAO Peng-ming(Department of Nephrology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院肾内科,兰州730030

出　　处：《中国血液净化》2023年第12期929-933,共5页Chinese Journal of Blood Purification

基　　金：兰州市科技发展指导性计划项目(2020-ZD-85);甘肃省自然科学基金一般项目(20JR10RA743)。

摘　　要：多发性骨髓瘤(multiple myeloma,MM)为第二大常见的血液系统恶性肿瘤,肾脏是MM的最重要且常见的受累器官之一,肾脏受损最常见的类型为骨髓瘤型肾病(myeloma cast nephropathy,MCN),主要机制是异常增生的浆细胞产生大量的血清游离轻链(serum free light chains,sFLCs),治疗难度大且预后差,肾损害是MM早期死亡的主要原因之一,sFLCs的迅速降低与肾功能的改善有关。高截留量血液透析(high cut-off hemodialysis,HCO-HD)因其大孔径的滤过膜,可高效清除过多的sFLCs,和硼替佐米等为基础的化疗联合使用有改善肾脏预后的趋势,经济效益存在争议,与高通量血液透析(high flux hemodialysis,HFHD)相比试验研究结果不一致,且目前尚无标准的HCO-HD方案,仍需要进一步的大规模、长时间随访的随机对照试验来评估HCO-HD对MCN患者临床结局的影响。本文就MCN的发病机制及HCO-HD在MCN中的临床应用作一简述。Multiple myeloma(MM)is the second commonest hematological malignant tumor.One of the most important and commonest organs damaged in MM is kidney,usually manifested as myeloma cast nephropathy(MCN)caused by a large number of serum free light chains(sFLCs)from malignant plasma cells.MCN is difficult to treat with poor prognosis,and is one of the main causes of early death in MM.Rapid reduction of sFLCs may improve the kidney function.High cut-off hemodialysis(HCO-HD)with the filters of large pore size can effectively clear the excessive sFLCs.HCO-HD combined with chemotherapy such as bortezomib lead to a tendency of better renal prognosis,but the economic benefit is yet controversial.The results of HCO-HD for MCN is inconsistent,if comparison is made with the results using high flux hemodialysis(HFHD).Currently,there is no standard HCO-HD protocol,and large-scale samples,long-term follow-up,and randomized controlled trials are required to evaluate the clinical outcomes of MCN patients treated by HCOHD.This article reviews the pathogenesis of MCN,and the clinical application of HCO-HD in MCN.

关 键 词：高截留量血液透析 骨髓瘤管型肾病 急性肾损伤 血清游离轻链 

分 类 号：R459.5[医药卫生—治疗学]