Superiority ntawm Cystatin C dhau Creatinine Rau Kev Ntsuas Thaum Ntxov Ntawm Kev Mob Raum Mob Hauv Pediatric Acute Lymphoblastic Leukemia / Lymphoblastic Lymphoma

Qhov tseeb tshwm sim ntawmmob raum mob(AKI) thaum chemotherapy raumob lymphoblastic leukemia(TAU)/lymphoblastic lymphoma (LBL) tsis paub. Tsis tas li ntawd, cov neeg mob qog noj ntshav thaum yau muaj kev pheej hmooAKI- mob raum mobkev hloov pauv. Yog li, kev kuaj mob ntxov ntawm AKI yog qhov tseem ceeb. Txoj kev tshawb no tsom los qhia qhov tshwm sim ntawm AKI hauv cov neeg mob uas tau txais tshuaj kho mob rau menyuam yaus ALL/LBL thiab los sib piv cov txiaj ntsig ntawm cov ntshav cystatin C (CysC)- thiab creatinine (Cr)-raws li kwv yees glomerular filtration rate (eGFR) raws li kev ntsuas ntsuas. Cov ntaub ntawv los ntawm 16 tus neeg mob nrog TAG NRHO / LBL kho nrog tag nrho ntawm 75 chav kawm ntawm kws khomob tau raug tshuaj xyuas rov qab. CysC- thiab Cr-based eGFR tau ntsuas ua ntej thiab peb zaug hauv ib lub lis piam thaum kho. Txhawm rau xam eGFR, ib qho kev sib npaug rau cov menyuam yaus Nyij Pooj tau siv. AKI tau kuaj pom thaum eGFR poob qis dua los yog sib npaug li 25% los ntawm qhov siab tshaj eGFR tus nqi tau txais nyob rau hauv 2 lub lis piam dhau los txij li pib siv tshuaj khomob. AKI tau muab qhab nia raws li kev pheej hmoo ntawm menyuam yaus, Kev raug mob, Kev Ua Tsis Taus, Poob, Qhov Kawg Theem Raum Kab Mob. Txhua tus neeg mob tsim AKI thaum siv tshuaj khomob; Txawm li cas los xij, ntau dua 90% ntawm cov mob tau mob me thiab thaum kawg rov zoo. Tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm AKI ntawm CysC- thiab Cr-based eGFR (p=0.104). Lub sijhawm nruab nrab ntawm AKI kuaj pom tau luv luv hauv CysC-based eGFR dua li hauv Cr-based eGFR (8 vs. 17 hnub, p < 0.001). Hauv txoj kev tshawb no, txhua tus neeg mob uas muaj menyuam yaus ALL/LBL tuaj yeem tsim AKI me me thaum kho. CysC-based eGFR yog qhov ntsuas tau zoo dua li Cr-based eGFR rau kev kuaj mob ntxov ntawm AKI.

Ntsiab lus: mob raum mob; mob lymphoblastic leukemia; kws khomob; creatinine; cystatin C

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Taw qhia

Mob raum raug mob(AKI) yog ib qho ntawm cov mob hnyav uas cuam tshuam nrog kev kho mob leukemia vim nws ua rau muaj kev tuag ntau ntxiv. Hauv cov neeg laus leukemia (mob myeloid leukemia thiabmuaj kev pheej hmoo siab myelodysplastic syndrome), ib feem peb ntawm cov neeg mob uas tau txais kev khomob khomob tsim AKI, thiab cov neeg mob no pom tau tias muaj tsib npaug ntawm cov neeg tuag (Lahoti li al. 2010). Txawm li cas los xij, nyob rau hauv cov neeg laus thiab menyuam yaus mob qog ntshav qog ntshav qog ntshav ntshav (TXL), qhov tshwm sim ntawm AKI thaum siv tshuaj khomob tsis paub tshwj tsis yog rau cov neeg muaj feem cuam tshuam nrog cov qog lysis syndrome lossis cuam tshuam nrog cov kws khomob tshwj xeeb xws li methotrexate (Perazella 1999), cisplatin (Pablo thiab Dong). 2008), thiab ifosfamide (Ciarimboli li al. 2011).

AKI yog ib qho kev pheej hmoo rau yav tom ntej kev loj hlob ntawm cov kab mob raum ntev (CKD), ib qho mob tshwm sim los ntawm kev ua haujlwm tsis zoo ntawm lub raum. Raws li cov ntaub ntawv dhau los los ntawm Childhood Cancer Survivor Study, feem ntau ntawm CKD yog li ntawm 2.4% mus rau 32% ntawm cov neeg muaj mob qog noj ntshav thaum yau (Kooijmans et al. 2019). Yog li, kev kuaj mob ntxov thiab kev kho mob ntawm AKI thaum siv tshuaj kho mob rau TXHUA tus, uas tuaj yeem txo qhov kev pheej hmoo ntawm kev hloov pauv AKI-CKD, muaj qhov tseem ceeb hauv kev kho mob.

Txawm tiasntshav creatinine(Cr) yog siv dav rau kev kuaj mob AKI, nws cuam tshuam los ntawm ntau yam uas tsis yog lub raum ua haujlwm, suav nrog kev sib deev, hnub nyoog, thiab cov leeg nqaij (Kellum li al. 2013). Cystatin C (CysC), uas tsis cuam tshuam los ntawm cov ntsiab lus saum toj no (Laterza li al. 2002), tuaj yeem tsim nyog thiab rhiab rau kev soj ntsuam ntawm lub raum ua haujlwm hauv cov menyuam yaus (Lankisch li al. 2006; Nakhjavan-Shahraki et ib. 2017).

Nyob rau hauv txoj kev tshawb no, peb tsom kom paub meej qhov tshwm sim ntawm AKI hauv menyuam yaus ALL / lymphoblastic lymphoma (LBL) thaum siv tshuaj khomob thiab sib piv cov txiaj ntsig ntawm CysC-based kwv yees glomerular filtration rate (eGFR) nrog Cr-based-eGFR hauv kev kuaj mob. ntawm AKI thaum ALL/LBL kho.

Cov ntaub ntawv thiab cov txheej txheem

Kev pom zoo ntawm kev ncaj ncees thiab kev tso cai los koom

Tag nrho cov txheej txheem ua tiav hauv txoj kev tshawb fawb no tau ua raws li cov qauv kev coj ua ntawm pawg neeg tshawb fawb hauv lub koom haum uas cov kev tshawb fawb tau ua (Kansai Medical University; tsis muaj. 2019288) thiab nrog 1964 Helsinki Tshaj Tawm thiab nws cov kev hloov kho tom qab lossis cov qauv kev coj ua zoo sib xws. Cov kws sau ntawv tsis tau sim cov tsiaj txhu hauv txoj kev tshawb no.

Cov neeg tuaj koom thiab cov qauv sau kaum plaub TAG NRHO cov neeg mob thiab ob tus neeg mob LBL hnub nyoog 2-18 xyoo kho nyob rau hauv Pediatric Department of Kansai Medical University Hospital txij lub Ob Hlis 2016 txog Lub Xya Hli 2020 tau suav nrog. Tsis muaj cov neeg tuaj koom tau pom qhov nce siab Cr lossis CysC vim mob qog nqaij hlav lysis lossis blast infiltration ntawm kev kuaj mob. Cov neeg mob tau txais tag nrho ntawm 75 chav kawm ntawm kws khomob. Serum CysC thiab Cr qib tau ntsuas los xam eGFR (CysC-raws li eGFR thiab Cr-based eGFR, ntsig txog) (Uemura li al. 2014a, b), ua ntej thiab peb zaug hauv ib lub lis piam nyob rau hauv txhua chav kawm ntawm chemotherapy. Muaj 14 chav kawm ntawm induction, 12 chav kawm ntawm kev sib sau ua ke thaum ntxov, 25 chav kawm ntawm kev sib koom ua ke, thiab 24 chav kawm ntawm kev rov ua dua tshiab (Table 1). Cov kws khomob no suav nrog cyclophosphamide, cytarabine, dasatinib, daunorubicin, doxorubicin, etoposide, ifosfamide, L-asparaginase, mercaptopurine, methotrexate, pirarubicin, vincristine, thiab vindesine. Cov neeg mob tau raug kho raws li Japanese Pediatric Leukemia / Lymphoma Study Group raws tu qauv.

Kev ntsuam xyuas ntawm AKI AKI tau kuaj pom thaum eGFR poob los ntawm 25% lossis ntau dua los ntawm qhov siab tshaj eGFR tus nqi tau txais nyob rau hauv 2 lub lis piam dhau los txij li pib siv tshuaj khomob. AKI tau muab qhab nia raws li kev pheej hmoo ntawm menyuam yaus, Kev raug mob, tsis ua haujlwm, poob, Lub Raum Kab Mob Kawg (pRIFLE) (Akcan-Arikan li al. 2007) raws li qhia hauv Table 2, txawm hais tias qhov txo qis hauv cov zis tso zis tsis tau siv hauv txoj kev tshawb no. . AKI tau kuaj pom siv CysC- thiab Cr-based eGFR ntawm nws tus kheej, thiab kev kuaj mob tau muab piv rau AKI qhov xwm txheej, qhov hnyav, thiab hnub kom txog thaum AKI kuaj xyuas txij thaum pib ntawm txhua chav kho mob.

Ntev mus ntev

Txhawm rau soj ntsuam cov txiaj ntsig ntawm lub raum mus ntev xws li kev txhim kho CKD, CysC-based eGFR tau ua raws li lub Peb Hlis 2021 nrog rau kev kuaj zis thiab ntshav. CKD tau raug soj ntsuam feem ntau siv cov kab mob raum: Txhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) txhais: muaj eGFR qis (eGFR < 90 mL / min / 1.73 m2 ) lossis proteinuria (cov protein ntau dua lossis sib npaug ntawm 1+ los ntawm cov tshuaj tso zis) (Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group 2013).

Cov txheej txheem txheeb cais

Cov ntaub ntawv ntawm kev sib deev, hnub nyoog, hom leukemia, kev pheej hmoo, tus naj npawb ntawm cov chav kawm, kev kho mob ntau npaum li cas, thiab lub sijhawm tau muab rho tawm los ntawm cov ntaub ntawv kho mob. Rau kev txheeb xyuas cov ntaub ntawv, Mann– Whitney U test lossis chi-square test tau siv, thiab p < 0.05 tau suav tias yog qhov tseem ceeb. Txhawm rau txheeb xyuas cov txiaj ntsig, tom qab kev soj ntsuam lub zog nrog qhov tseem ceeb ntawm qib 0.05 tau ua tiav siv G*Power version 3.1.9.4 (Heinrich-Heine University, Düsseldorf, Germany) (Faul et al. 2007).