儿童肾移植术后 6 个月贫血的发生率及相关因素

Incidence and associated factors of anemia within six months after kidney transplan- tation in pediatric recipients

摘要

目的：贫血是儿童肾移植术后常见的并发症，其流行病学特征与相关因素尚未完全明确。本研究通过分析儿童肾移植术后 6 个月内贫血的临床特征，探寻贫血发生的相关因素，为精准防控提供循证依据。方法：采用单中心回顾性队列研究，纳入 2022 年1月至2025年8月期间北京大学人民医院完成的儿童肾移植病例的临床资料。采集患者人口学信息、围手术期及术后 6 个月的动态实验室指标，依据世界卫生组织（World Health Organization， WHO）年龄分层标准诊断贫血。通过单因素分析、多因素二元 Logistic 回归及受试者工作特征（receiver operating characteristic，ROC）曲线，筛选独立相关因素并评估诊断价值。结果：本研究队列共纳入 46 例患儿，术后 6 个月贫血的发生率为 41.3% (19/46)  ，贫血类型以正细胞性贫血为主（63.1%,12/19）。多因素二元 Logistic 回归分析显示，年龄（OR=0.293, P=0.018）、术后 6 个月血尿素（OR=3.281, P=0.006）和估算肾小球滤过率（estimated glo-merular filtration rate，eGFR）(OR=0.893, P=0.030) 与贫血独立相关。探索性分层分析提示，年龄<13岁、血尿素 >7mmol/L 和 eGFR<120 mL/（min • 1.73 m²）可能作为临床筛查的参考阈值。ROC 曲线分析显示，术后血尿素水平对贫血的诊断价值最优（曲线下面积 =0.890, P<0.001）。结论：儿童肾移植术后贫血发生率较高，以轻中度正细胞性贫血为主，与低龄及移植肾功能相关，贫血组与非贫血组患儿血红蛋白水平的差异自术后第 3 个月开始显现。临床中应重点监测年龄<13 岁、血尿素水平>7 mmol/L、术后 eGFR<120 mL/（min • 1.73 m²）的高危患儿，及时干预有助于减少术后贫血的发生或改善其严重程度。

Abstract

Objective：Anemia is a common complication following kidney transplantation in children ， yet its epidemiological characteristics and associated factors are not fully understood.This study aimed to investigate the incidence and clinical features of anemia within six months after pediatric kidney trans- plantation and to identify its associated factors，thereby providing evidence for management. Methods：A single-center retrospective cohort study was conducted on pediatric patients who underwent kidney trans- plantation at Peking University People＇s Hospital from January 2022 to August 2025.Demographic，peri- operative，and serial laboratory data up to 6 months post-transplantation were collected.Anemia was diagnosed according to the World Health Organization（WHO）age-specific criteria.Univariate analysis ， multivariate binary Logistic regression，and receiver operating characteristic（ROC）curve analysis were performed to identify associated factors and assess their diagnostic value. Results：The study included 46 pediatric recipients.The incidence of anemia within 6 months post-transplantation was 41.3％（19/46）， with normocytic anemia being the most prevalent type（63.1％，12/19）.Multivariate binary Logistic re- gression analysis showed that age（OR=0.293,P=0.018），postoperative serum urea at 6 months (OR=3.281,P=0.006) ，and estimated glomerular filtration rate（eGFR）(OR=0.893,P=0.030) were independently associated with anemia.Exploratory stratified analysis suggested that age<13 years， serum urea >7mmol/L ，and eGFR $<120\text{ }\mathrm{m}\mathrm{L}/\left(\mathrm{m}\mathrm{i}\mathrm{n}\cdot 1.73{\text{ }\mathrm{m}}^{2}\right)$ might serve as reference thresholds for clinical screening.ROC curve analysis indicated that postoperative serum urea had the best diagnostic value for anemia（area under the curve =0.890,P<0.001）.Hemoglobin levels began to differ signifi- cantly between the anemic and non-anemic groups from the third month postoperative onward，with the gap widening over time. Conclusion：This study demonstrates a high incidence of early-onset anemia af- ter pediatric kidney transplantation，primarily mild to moderate normocytic anemia.It is associated with younger age and suboptimal allograft function，with the divergence in hemoglobin levels becoming apparent from the third month postoperative.Close monitoring of high-risk children，particularly those aged<13 years or with serum urea>7 mmol/L and eGFR<120 mL/（min⋅1.73 m²），and early in- tervention may help reduce the occurrence or severity of post-transplant anemia.

关键词

儿童 / 肾移植 / 贫血 / 尿素 / 肾小球滤过率

Key words

Child / Kidney transplantation / Anemia / Urea / Glomerular filtration rate

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基金资助

国家自然科学基金(82570886)

北京大学人民医院研究与发展基金(RDGS2023-09)