Superiority ntawm Cystatin C dhau Creatinine Rau Kev Tshawb Fawb Txog Thaum Ntxov Ntawm Lub raum Kev Kho Mob Hauv Pediatric Acute Lymphoblastic Leukemia / Lymphoblastic Lymphoma Ⅲ

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Peb txoj kev tshawb fawb tau qhia tias txhua tus neeg mob tau ntsib AKI tsawg kawg ib zaug thaum ALL / LBL kev kho mob thiab AKI tau kuaj pom hauv 77% ntawm tag nrho cov kev kho mob uas siv CysC-based eGFR. Ib txoj kev tshawb fawb tau tshaj tawm txog 16.2% qhov tshwm sim hauv ib pawg ntawm 831 tus neeg mob tau txais tshuaj kho mob rau cov menyuam yaus mob ntshav qab zib mellitus tshiab (Fisher et al. 2010). Lwm daim ntawv tshaj tawm qhia pom qhov tshwm sim ntawm 39% ntawm AKI hauv kev tshawb fawb ntawm 23 tus menyuam yaus uas muaj qog nqaij hlav (McMahon li al. 2018). Rau peb txoj kev paub, tsis muaj kev tshawb fawb tau soj ntsuam qhov tshwm sim ntawm AKI ntawm cov neeg mob ALL / LBL. Hauv txoj kev tshawb fawb tam sim no, qhov tshwm sim ntawm AKI thaum siv tshuaj khomob yuav siab dua qhov kev cia siab ntawm cov npe menyuam yaus oncology lossis lwm yam uas tau tshaj tawm yav dhau los hauv cov neeg mob qog noj ntshav. Qhov tsis sib xws ntawm qhov tshwm sim ntawm AKI tuaj yeem piav qhia los ntawm ntau qhov laj thawj. Ua ntej, kev ntsuam xyuas ntau zaus ntawm lub raum ua haujlwm raws li cov lus qhia ntawm cov kws kho mob nephrologists, kuaj ntshav tsawg kawg 3 zaug hauv ib lub lis piam, ua rau muaj kev saib xyuas ntau dua, thiab peb tuaj yeem kuaj tau txawm tias mob AKI. Qhov thib ob, cov qauv sib txawv tau siv hauv cov kev tshawb fawb yav dhau los. Rau kev kuaj mob ntawm AKI, qee qhov kev tshawb fawb tau siv cov kab mob hauv lub raum: Txhim kho Cov Txheej Txheem Thoob Ntiaj Teb (Sutherland et al. 2015; Meersch et al. 2017) lossis cov qauv pRIFLE (Sethi li al. 2015; Sutherland et al. 2015), thaum. lwm tus tau siv International Statistical Classification of Diseases and Related Health Problems codes (Ko et al. 2018). Thib peb, cov tshuaj siv hauv cov txheej txheem sib txawv tuaj yeem cuam tshuam cov txiaj ntsig. Plaub, Cr-based eGFR tau siv los ntsuas lub raum ua haujlwm hauv kev tshawb fawb feem ntau (McMahon li al. 2018), thiab CysC-based eGFR tsis tshua siv (Yong et al. 2017; Nakamura li al. 2018).

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Kev txhim kho hauv kev kuaj mob thiab kev kho mob ntawmcov neeg mob qog noj ntshavtau ua rau muaj kev nce ntxiv ntawm cov neeg mob qog noj ntshav. Txawm li cas los xij, ntau tus neeg mob qog noj ntshav thaum yau muaj teeb meem kev noj qab haus huv ntau xyoo tom qab ntawdqhov tshwm sim ntawm lawv txoj kev kho mob qog noj ntshav. Koojmans et al. (2019) tau tshuaj xyuas cov kev tshawb fawb yav dhau los ntawm lub raum tsis ua haujlwm hauv cov menyuam yaus uas muaj mob qog noj ntshav. Lawv tau tshaj tawm tias feem ntau ntawm CKD yog li ntawm 2.4% mus rau 32%. Lwm txoj kev tshawb fawb tau tshaj tawm tias 0.5% ntawm ntau dua 10,000 cov neeg mob qog noj ntshav thaum yau tau kho nyob rau xyoo 1970 thiab 1980s tau tsim lub raum tsis ua haujlwm lossis xav tau kev lim ntshav los ntawm 18 xyoo tom qab kuaj mob qog noj ntshav thawj zaug. Lawv muaj cuaj npaug siab dua lawv cov kwv tij uas tsis muaj mob qog noj ntshav (Oeffinger li al. 2006). Chemotherapy-induced AKI yog tus cwj pwm los ntawm ntau lub xeev pathological xws li podocyte tauopathy, mob tubular raug mob, thiab siv lead ua nephropathy (Perazella 2012). Txawm hais tias AKI rov zoo, kho tsis zoo, thiab rov raug mob ntau zaus tuaj yeem ua rau tubulointerstitial fibrosis thiab glomerulosclerosis uas ua rau CKD (Venkatachalam li al. 2015; Basile li al. 2016), peb qhov kev tshawb pom qhia tias cov kws kho mob yuav tau saib xyuas me ntsis AKIs. Cov neeg mob qog noj ntshav feem ntau tau kawm ntau yam kev kho mob, uas tuaj yeem ua rau mob raum rov qab thiab nce ntxivkev pheej hmoo ntawm CKD. Yog li, oncologists ua ke nrog nephrologists yuav tsum ua tib zoo xyuas txawm tias mob AKI thaum siv tshuaj khomob.

Hauv kev kawm tam sim no, thaum 75 chav kawm, AKI tau kuaj pom hauv 58 chav kawm los ntawm CysC-based eGFR (77%) thiab 49 chav kawm los ntawm Cr-based eGFR (65%). Ntawm cov xwm txheej no, kev kuaj mob ntawm AKI tau pom zoo pom zoo siv ob qhov kev ntsuas ntsuas hauv 42 chav kawm. Los ntawm qhov sib txawv, muaj qhov sib txawv ntawm qhov tshwm sim ntawm AKI kuaj pom los ntawm CysC-based eGFR thiab Cr-based eGFR hauv 23 chav kawm, txawm hais tias tsis muaj qhov sib txawv tseem ceeb hauv qhov xwm txheej ntawm AKI tsis hais seb CysC-based eGFR lossis Cr-based eGFR. tau siv rau kev kuaj mob (p=0.104). Peb xav kom cov txheej txheem hauv qab no ua rau muaj qhov tsis sib xws: Ntawm xya qhov kev kuaj mob AKI tsuas yog los ntawm Cr-based eGFR, rau tus neeg mob (86%) tau txais asparaginase tam sim ua ntej kev txhim kho AKI. Txij li thaum asparaginase tuaj yeem txo cov ntshav CysC los ntawm kev txo qis cov ntshav triiodothyronine, uas txhawb nqa CysC tso tawm ntawm cov leeg nqaij los ntawm kev hloov pauv kev loj hlob-beta 1, AKI soj ntsuam siv CysC-based eGFR yuav raug saib xyuas vim qhov txo qis hauv cov ntshav CysC hauv cov neeg mob tau txais asparaginase ( Ferster et al. 1992; Kotajima et al. 2010). Lub caij no, ntawm 16 chav kawm kuaj mob AKI los ntawm kev siv CysC-based eGFR ib leeg, feem ntau muaj tus qhab nia Z tsis zoo rau lub cev qhov hnyav, qhia tias lawv tau txo cov leeg nqaij. Txij li cov ntshav Cr qib feem ntau cuam tshuam los ntawm cov leeg nqaij, qhov no yuav ua rau muaj qhov tsis tseeb-nega tiv thaiv cov txiaj ntsig hauv kev kuaj mob ntawm AKI tso siab rau Cr-based eGFR. Qhov tseem ceeb, Rayar et al. (2013) tau tshaj tawm tias cov menyuam yaus uas muaj TAG NRHO muaj cov leeg pob txha qis (txhais tau tias Z tus qhab nia ntawm −0.18) dua li cov menyuam noj qab haus huv thaum lub sijhawm kuaj mob

Serum Cr feem ntau yog siv rau hauv kev kuaj mob ntawm AKI thiab kev saib xyuas ntawmlub raum ua haujlwm. Txawm li cas los xij, nws cov qib yuav tsis hloov mus txog thaum kwv yees li 50% ntawm lub raum ua haujlwm tau ploj lawm (Nguyen thiab Devarajan 2008). CysC yog cov protein uas tsis muaj molecular hnyav tas li tsim thiab zais los ntawm cov hlwb nucleated thoob plaws lub cev. Nws yog lim dej dawb los ntawm glomerulus thiab tag nrho reabsorbed thiab metabolized los ntawm lub raum proximal tubules; nws muaj qhov sib cuam tshuam nrog GFR raws li ntsuas siv cov xov tooj cua isotopes (Coll li al. 2000). Vim yog cov yam ntxwv lom neeg, CysC tuaj yeem tsim nyog rau kev soj ntsuam ntawm lub raum ua haujlwm hauv cov menyuam yaus (Lankisch li al. 2006; Nakhjavan Shahraki et al. 2017). Ib qho kev ntsuam xyuas meta tsis ntev los no tau pom qhov zoo tshaj ntawm CysC tshaj Cr hauv kev kuaj mob AKI (Nakhjavan-Shahraki li al. 2017), uas nthuav tawm lwm txoj hauv kev rau kev kuaj mob ib txwm muaj hauv nephrology. Txawm li cas los xij, kev tswj hwm glucocorticoid hauv cov neeg laus uas muaj mob hawb pob thiab cov qog nqaij hlav tuaj yeem ua rau cov ntshav CysC nce qib ntawm lub raum tsis ua haujlwm, txawm tias qhov tseeb mechanism tseem tsis paub (Bjarnadottir li al. 1995; Manetti li al. 2005). Qhov no tuaj yeem ua rau muaj qhov tsis tseeb ntawm AKI yog kev soj ntsuam los ntawm CysC-based eGFR. Hauv qhov sib piv, muaj kev sib cav txog seb glucocorticoids puas cuam tshuam rau cov ntshav CysC hauv cov neeg mob menyuam yaus (Bokenkamp li al. 2002; Foster et al. 2006; Bokenkamp et al. 2007; Bardi et al. 2010; Slort et al. 2010). Yog li, hauv txoj kev tshawb fawb tam sim no, qhov tshwm sim ntawm AKI tau muab sib piv los ntawm kev kho mob glucocorticoid. Cov txiaj ntsig tau pom tsis muaj qhov sib txawv tseem ceeb ntawm ob txoj kev tswj hwm ntawm AKI: qhov qub yog 77.4%, thaum tom kawg yog 77.3% (Table 3). Tsis tas li ntawd, cov kev hloov pauv nyob rau hauv tus nqi ntawm CysC-based eGFR txo qis thaum lub sijhawm 42 chav kawm ntawm AKI, uas suav nrog 28 chav kawm nrog glucocorticoids, pom kev txhim kho hauv lub raum ua haujlwm hauv 12 hnub txawm hais tias kev tswj hwm glucocorticoid txuas ntxiv 2 lub lis piam. Ua ke, peb ntseeg tias glucocorticoids muaj qhov cuam tshuam tsis zoo ntawm cov ntshav CysC qib thiab CysC-based eGFR thiab cov txiaj ntsig ntawm peb txoj kev tshawb fawb qhia tias CysC-based eGFR yog qhov rhiab dua li Cr-based eGFR rau kev ntsuas lub raum ua haujlwm hauv cov neeg mob TAG NRHO / LBL. Peb kuj tau sib piv AKI qhov xwm txheej los ntawm hom kev kho tshuaj khomob. AKI feem ntau tshwm sim thaum cov chav kawm sib sau ua ke, tej zaum yog vim kev siv cov tshuaj methotrexate siab. Txawm hais tias tsis yog qhov tseem ceeb, hauv txhua plaub hom kev kawm, AKI tau kuaj pom ntau dua thaum txhais tau tias siv CysC-based eGFR piv rau Cr-based eGFR, uas qhia tau hais tias muaj txiaj ntsig ntawm CysC-based eGFR hauv kev kuaj mob AKI thaum siv tshuaj khomob.

Txawm hais tias ob qho tib si CysC- thiab Cr-based eGFR muaj qhov zoo thiab qhov tsis zoo, peb pom qhov tseebQhov zoo ntawm CysC-based eGFRdhau Cr-raws li eGFR rau kev kuaj mob ntxov ntawm AKI hauv cov neeg mob menyuam yaus nrog TAG NRHO / LBL tab tom siv tshuaj khomob. Tshawb xyuas AKI thaum ntxov yuav tso cai rau kev tiv thaiv tsim nyog los tiv thaiv lub raum tsis zoo ntxiv. Muaj peev xwm tiv thaiv kev kho mob nrog rau kev txo cov tshuaj noj, kev haus dej, kev tswj hwm cov tshuaj diuretics (Horie li al. 2018), thiab lwm yam tshuaj tiv thaiv raum yuav pab txhawb kev tiv thaiv CKD yav tom ntej. Hauv txoj kev tshawb no, peb tau ua raws li cov neeg mob rau qhov nruab nrab ntawm 29 lub hlis tom qab rov ua cov kev kawm kom paub meej txog kev txhim kho ntawm CKD; tsis muaj neeg mob tau txo eGFR. Txij li cov neeg mob uas tau ntsib AKI muaj kev pheej hmoo ntawm CKD yav tom ntej, peb yuav txuas ntxiv mus ntxiv.

Txoj kev tshawb no muaj qee qhov kev txwv uas yuav tsum tau xav txog. Ua ntej, raws li tag nrho cov kev tshawb fawb cov neeg mob tau zoo lawm, tsis muaj kev cuam tshuam los ntawm AKI. Cov kev tshawb fawb ntxiv yog xav tau los txiav txim siab seb puas tuaj yeem rov qab tau nrawm nrog kev cuam tshuam, xws li txo cov tshuaj tiv thaiv kab mob, cov kua dej ntau ntau, lossis alkaliza tion. Ntxiv mus, cov kev tshawb fawb yav tom ntej yuav tsum tau txiav txim siab seb qhov kev cuam tshuam thaum ntxov tuaj yeem txo qhov kev pheej hmoo ntawm kev loj hlob ntawm CKD. Qhov thib ob, cov tshuaj los ntawm cov kev kho mob yav dhau los yuav muaj qhov cuam tshuam rau cov kev kawm tom ntej. Txawm li cas los xij, vim tias qhov nruab nrab CysC-based eGFR thaum pib ntawm txhua chav kho mob yog 160 (IQR, 135 txog 181), peb ntseeg tias qhov muaj peev xwm no tsawg heev. Thib peb, tus qauv loj me me. Txawm li cas los xij, tus qauv loj txaus rau kev ntsuam xyuas thawj qhov tshwm sim ntawm lub sijhawm rau kev kuaj mob AKI. Cov nyhuv loj hauv peb txoj kev tshawb fawb yog 0.609, uas yog txaus rau cov ntaub ntawv tsis yog parametric. Cov qauv me me txwv tsis pub muaj kev tshawb fawb ntxiv txog qhov cuam tshuam ntawm tus kheej cov txheej txheem kho lossis tshuaj. Cov kev tshawb fawb ntxaws ntxiv nrog cov neeg mob ntau dua yog tsim nyog

Hauv kev xaus, cov txiaj ntsig ntawm peb txoj kev tshawb fawb tau hais txog ob qho tseem ceeb ntsig txog AKI hauv cov neeg mob uas tau txais tshuaj kho mob rau menyuam yaus ALL / LBL. Ua ntej, peb tau pom qhov muaj peev xwm ntawm AKI siab ntawm cov neeg mob. Txawm hais tias nephrotoxicity paub zoo nrog kev siv tshuaj khomob siv qee cov tshuaj tshwj xeeb, tsis muaj daim ntawv tshaj tawm tam sim no tau ntsuas nephrotoxicity vim ALL / LBL kev kho mob hauv menyuam yaus. Kev soj ntsuam tsis tu ncua ua rau peb pom txawm tias mob AKI. Thib ob, CysC-raws li eGFR tso cai kuaj pom ua ntej ntawm AKI dua li Cr-based eGFR. Yog li, txiav txim siab txog qhov nws thiab qhov tsis zoo ntawm CysC-based eGFR thiab Cr-based eGFR hauv kev kuaj mob me nyuam yaus AKI thaum siv tshuaj khomob, peb xav kom nquag ua haujlwm rau lub raum los ntawm ob qho kev ntsuas.

Kev lees paub

Peb xav ua tsaug rau Editage (https://www.editage. com) rau kev kho lus Askiv.

Sau Kev Pabcuam SA, ST, thiab KK tsim qhov kev kawm; TY, SA, thiab YA tau sau cov ntaub ntawv; TY, SA, YA, thiab SY txheeb xyuas cov ntaub ntawv; TY, SA, MR, thiab YA tau sau cov ntawv sau; thiab SY, TO, TK, thiab ST tau muab kev txhawb nqa thiab tshuaj xyuas cov ntawv sau. KK saib xyuas tag nrho cov txheej txheem kawm. Txhua tus kws sau ntawv tau nyeem thiab pom zoo cov ntawv sau kawg. Kev tsis sib haum xeeb ntawm kev txaus siab Cov neeg sau ntawv tshaj tawm tsis muaj teeb meem ntawm kev txaus siab.

Cov ntaub ntawv

Akcan-Arikan, A., Zappitelli, M., Loftis, LL, Washburn, KK, Jefferson, LS & Goldstein, SL (2007) Hloov kho RIFLE cov qauv hauv cov me nyuam mob hnyav nrog mob raum raug mob.Raum Int, 71, 1028-1035 ib. Bardi, E., Dobos, E., Kappelmayer, J. & Kiss, C. (2010) Kev sib txawv ntawm corticosteroids ntawm cov ntshav cystatin C hauv thrombocytetopic purpura thiab leukemia.Pathol. Oncol. Res., 16, 453-456. 

Basile, DP, Bonventre, JV, Mehta, R., Nangaku, M., Unwin, R., Rosner, MH, Kellum, JA & Ronco, C.; ADQI XIII Kev Ua Haujlwm Pab Pawg (2016) Kev nce qib tom qab AKI: nkag siab txog cov txheej txheem kho kho tsis zoo los kwv yees thiab txheeb xyuas cov kev kho mob.J. Am. Soc. Nephrol., 27, 687-697. 

Bjarnadottir, M., Grubb, A. & Olafsson, I. (1995) Txhawb kev sib kho, dexamethasone-induced nce hauv cystatin C ntau lawm los ntawm HeLa hlwb.Luam theej duab. J. Clin. Lab. Kev nqis peev., 55, 617-623 ib. Bokenkamp, ​​A., Laarman, CA, Braam, KI, van Wijk, JA, Kors, WA, Kool, M., de Valk, J., Bouman, AA, Spreeuwenberg, MD & Stoffel-Wagner, B. (2007)

Cov txiaj ntsig ntawm kev kho corticosteroid ntawm cov protein tsawg-molecular-yuag cov cim ntawm lub raum ua haujlwm.Clin. Chem., 53, 2219-2221 ib. Bokenkamp, ​​A., van Wijk, JA, Lentze, MJ & Stoffel-Wagner, B. (2002) Cov nyhuv ntawm kev kho corticosteroid ntawm cov ntshav cystatin C thiab beta2-microglobulin concentrations.

Clin. Chem., 48, 1123-1126 ib. Ciarimboli, G., Holle, SK, Vollenbrocker, B., Hagos, Y., Reuter, S., Burckhardt, G., Bierer, S., Herrmann, E., Pavenstadt, H., Rossi, R., Kleta , R. & Schlatter, E. (2011) New clues for nephrotoxicity induced by ifosfamide: preferential renal uptake from the human organic cation transporter 2.Mol. Pharm., 8, 270-279.