Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China.
Department of Hematology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
Br J Hosp Med (Lond). 2024 Oct 30;85(10):1-16. doi: 10.12968/hmed.2024.0356. Epub 2024 Oct 24.
Although the incidence of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively low, it can significantly affect patients' quality of life and may even be life-threatening. Therefore, it is essential to investigate the clinical manifestations and prognosis of patients with NS after allo-HSCT, as well as to identify potential high-risk factors associated with this condition. We investigated the incidence rate of NS in 1457 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the First Affiliated Hospital, Zhejiang University School of Medicine between June 2007 and March 2020. Among these, we identified 12 patients who developed NS after allo-HSCT (NS group). For comparison, we selected a control group of 48 patients matched by gender and transplantation time who did not develop NS. Univariate and multivariate logistic regression analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA) to identify independent risk factors for NS. Among the 1457 patients, 12 (0.82%) developed post-transplantation NS, with a median onset time of 14.99 months (range: 5.39-48.43 months) after transplantation. Univariate analysis indicated that the occurrence of post-transplantation NS was significantly correlated with total cholesterol (TC) levels at 6 months post-transplantation ( = 0.041), triglycerides (TG) and TC levels at 1 year post-transplantation ( = 0.004 and = 0.011, respectively), and cytomegalovirus (CMV) infection ( = 0.002). Multivariate analysis revealed that CMV infection ( = 0.004, odds ratio = 15.871; 95% confidence interval: 2.465-102.194) was independently associated with the development of NS. After allo-HSCT, NS may manifest as a form of chronic graft-versus-host disease. CMV infection is a risk factor for developing NS. Effective management through the administration of calcium inhibitors and corticosteroids can enable long-term survival in these patients.
虽然异基因造血干细胞移植（allo-HSCT）后肾病综合征（NS）的发病率相对较低，但它会显著影响患者的生活质量，甚至可能危及生命。因此，研究 allo-HSCT 后 NS 患者的临床表现和预后，并确定与该疾病相关的潜在高危因素至关重要。
我们调查了 2007 年 6 月至 2020 年 3 月在浙江大学医学院第一附属医院接受异基因造血干细胞移植（allo-HSCT）的 1457 例患者中 NS 的发生率。其中，我们确定了 12 例 allo-HSCT 后发生 NS 的患者（NS 组）。为了比较，我们选择了 48 例性别和移植时间匹配但未发生 NS 的患者作为对照组。使用 SPSS 软件（版本 25.0；IBM 公司，纽约州阿蒙克）进行单变量和多变量逻辑回归分析，以确定 NS 的独立危险因素。
在 1457 例患者中，有 12 例（0.82%）发生移植后 NS，移植后中位发病时间为 14.99 个月（范围：5.39-48.43 个月）。单变量分析表明，移植后 NS 的发生与移植后 6 个月的总胆固醇（TC）水平（ = 0.041）、移植后 1 年的甘油三酯（TG）和 TC 水平（ = 0.004 和 = 0.011）以及巨细胞病毒（CMV）感染（ = 0.002）显著相关。多变量分析显示，CMV 感染（ = 0.004，优势比= 15.871；95%置信区间：2.465-102.194）与 NS 的发生独立相关。
allo-HSCT 后，NS 可能表现为一种慢性移植物抗宿主病。CMV 感染是发生 NS 的危险因素。通过钙抑制剂和皮质类固醇的有效治疗管理，可以使这些患者实现长期生存。
