Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Division of Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Pediatr Blood Cancer. 2020 Aug;67(8):e28209. doi: 10.1002/pbc.28209. Epub 2020 May 30.
Patients with high-risk neuroblastoma (HR NBL) treated with myeloablative regimens are reported to be at risk for cardiovascular morbidity, and this risk may be increased by impaired renal function.
Long-term renal function was assessed in a national cohort of 18 (age 22.4 ± 4.9 years) HR NBL survivors by plasma creatinine (P-Cr), urea, and cystatin C (P-Cys C) concentrations, urine albumin/creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). Ambulatory blood pressure was monitored, and common carotid intima-media thickness (CIMT) and left ventricular mass index (LVMI) were evaluated.
No significant difference in P-Cr, P-Cys C, or eGFR was found between the NBL survivors and the age- and sex-matched 20 controls. P-Cys C-based eGFR (eGFRcysc) was significantly lower than the P-Cr-based eGFRcr (97 ± 17 mL/min/1.73 m vs 111 ± 19 mL/min/1.73 m , P < 0.001) among the NBL survivors. The eGFRcysc was below normal in 28%, and ACR was above normal in 22% of the NBL survivors. Abnormal blood pressure was found in 56% of the survivors, and an additional 17% were normotensive at daytime but had significant nocturnal hypertension. Both ACR and P-Cys C were associated with nighttime diastolic hypertension.
Long-term survivors of childhood HR NBL showed signs of only mild renal dysfunction associated with diastolic hypertension. Elevated ACR and P-Cys C were the most sensitive indicators of glomerular renal dysfunction and hypertension in this patient cohort.
接受清髓性治疗方案治疗的高危神经母细胞瘤（HR NBL）患者存在心血管发病率风险，而肾功能受损可能会增加这种风险。
通过血浆肌酐（P-Cr）、尿素和胱抑素 C（P-Cys C）浓度、尿白蛋白/肌酐比值（ACR）和估算肾小球滤过率（eGFR）评估全国范围内 18 例（年龄 22.4 ± 4.9 岁）HR NBL 幸存者的长期肾功能。监测了动态血压，评估了颈总动脉内膜中层厚度（CIMT）和左心室质量指数（LVMI）。
NBL 幸存者与年龄和性别匹配的 20 名对照者之间，P-Cr、P-Cys C 或 eGFR 无显著差异。与基于 P-Cr 的 eGFRcr 相比，基于 P-Cys C 的 eGFRcysc（97 ± 17 mL/min/1.73 m2 与 111 ± 19 mL/min/1.73 m2 ，P < 0.001）显著降低。NBL 幸存者中有 28% 的 eGFRcysc 低于正常值，22% 的 ACR 高于正常值。幸存者中 56% 的人血压异常，另外 17% 的人白天血压正常，但夜间有显著的高血压。ACR 和 P-Cys C 均与夜间舒张压高血压相关。
儿童期 HR NBL 的长期幸存者表现出仅与舒张期高血压相关的轻度肾功能障碍迹象。在该患者队列中，升高的 ACR 和 P-Cys C 是肾小球肾功能障碍和高血压的最敏感指标。
