EBV相关噬血细胞综合征并发急性肾损伤患者的临床特点分析  

Clinical Characteristics Analysis of EBV-associated Hemophago-cytic Lymphohistiocytosis Patients with Acute Kidney Injury

作　　者：赵梦雅[1] 邱昱 刘景峰[1] 郭东晨[1] 林瑾[1] ZHAO Meng-Ya;QIU Yu;LIU Jing-Feng;GUO Dong-Chen;LIN Jin(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京100050

出　　处：《中国实验血液学杂志》2024年第4期1248-1257,共10页Journal of Experimental Hematology

摘　　要：目的:分析EB病毒(EBV)感染相关噬血细胞综合征(HLH)患者并发急性肾损伤(AKI)的临床特点。方法:收集2014年1月至2020年12月期间于本院住院治疗的EBV相关HLH患者,对患者的临床特征、治疗、并发AKI情况及预后进行回顾性分析。结果:本研究中EBV-HLH患者的AKI发生率为65.5%,28 d死亡率为15.3%。与未发生AKI组患者比较,并发AKI的EBV-HLH患者的胆红素、乳酸脱氢酶、肌酐、尿素氮、β_(2)-微球蛋白(β_(2)-MG)的水平更高,凝血功能更差,可溶性白细胞介素-2受体(sCD25)更低。AKI组患者接受化疗、移植、机械通气、应用血管活性药物的比例更高,住院时间更长,住院病死率及28 d病死率更高。AKI患者按照改善全球肾脏预后组织(KDIGO)分级进行亚组分析,白细胞、胆红素、白蛋白、肌酐、尿素氮、β_(2)-MG、活化部分凝血活酶时间(APTT)、凝血酶原时间(PTA)水平更能反应患者病情的严重程度,KDIGO 2级和3级的患者接受移植、利尿剂、脏器支持(机械通气、应用血管活性药物、肾替代治疗)和入住重症监护病房的比例更高,住院病死率和28 d病死率更高。回归分析发现,肌酐、β_(2)-MG、APTT、移植、化疗是AKI发生的独立危险因素;应用血管活性药物既是AKI发生的独立危险因素,也是28 d死亡的独立危险因素;化疗、住院时间、HGB及纤维蛋白原水平是28天死亡的保护性因素。结论:EBV-HLH患者的AKI发生率高,进展为重症病死率高,应早期重视、加强关注,从而进行早期治疗以改善预后。Objective:To analyze the clinical characteristics of patients with Epstein-Barr virus(EBV)-as sociated hemophagocytic lympbohistiocytosis(HLH)with acute kidney injury(AKI).Methods:EBV-HLH patients who were hospitalized in our hospital from January 2014 to December 2020 were collected,and their clinical characteristics,treatment,concurrent acute kidney injury and prognosis were retrospectively analyzed.Results:In this study,the incidence of AKI complicated by EBV-HLH was 65.5%,and the 28-day mortality rate was 15.3%。Compared with non-AKI group,patients in the AKI group had higher levels of bilirubin,lactate dehydrogenase,creatinine,urea nitrogen,andβ-microglobulin(β_(2)-MG),poorer coagulation,and lower soluble IL-2 receptor(sCD25).Patients in the AKI group had a higher proportion of chemotherapy,transplantation,mechanical ventilation,and the application of vasoactive medications,and were hospitalized for longer periods of time,with higher in-hospital mortality rates and 28-day mortality rates.Patients in the AKI group were analyzed in subgroups according to the Kidney Disease Improving Global Outcomes(KDIGO)clasification,and the levels of leukocytes,bilirubin,albumin,creatinine,urea nitrogen,β_(2)-MG,activated partial thromboplastin time(APTT),and prothrombin time activity(PTA)were more responsive to the severity of the patient's condition.KDIGO grade 2 and 3 had higher proportions of receiving transplants,diuretics,organ support(mechanical ventilation,application of vasoactive medications,and renal replacement therapy),and admissions to the intensive care unit(ICU),and with higher in-hospital mortality rates and 28 day mortality rates.Regression analysis found that creatinine,β_(2)-MG,APTT,transplantation,and chemotherapy were independent risk factors for the development of AKI;the application of vasoactive drugs was both an independent risk factor for the development of AKI and for death at 28 days;and chemotherapy,length of hospitalization,and HGB and fbrinogen levels were protective factors for death at

关 键 词：噬血细胞综合征 EB病毒感染 急性肾损伤 预后 

分 类 号：R551.2[医药卫生—血液循环系统疾病] R692.5[医药卫生—内科学]