Abstract:

Objective To explore the risk factors for developing high-grade urothelial carcinoma in kidney transplant patients with chronic renal insufficiency and progression to uremia after taking traditional Chinese medicine containing aristolochic acid， and to establish its prediction model. Methods A total of 70 patients diagnosed with aristolochic acids nephropathy （AAN） and diagnosed with urothelium carcinoma （UC）after allograft kidney transplantationin Beijing Friendship hospital from January 2003 to January 2025 were included in this study. The patients were divided into high-grade urothelial carcinoma group （HUC group，55 cases in total） and low-grade urothelial carcinoma group （LUC group，15 cases in total） according to their pathological grade. The epidemiological data， general status after transplantation，hydronephrotic conditions and viral infection of patients between the two groups were collected and compared. T test，MannWhitney test and Chi-square test were used to explore the risk factors leading to high-grade urothelial carcinoma， and independent risk factors were analyzed by multiple logistic regression to obtain a prediction model. The accuracy of the prediction model is verified by internal verification. Results There were no statistically significant differences in clinical data such as gender， BMI， previous medical history， estimated glomerular filtration rate （eGFR） at the time of urothelial carcinoma occurrence， thetime from kidney transplantation to the occurrence of urothelial carcinoma， the location of the initial tumor discovery， and the immunosuppressive regimen after transplantation between the HUC group and the LUC group. However， a longer dialysis duration before transplantation， a higher systemic immune inflammatory index （SII） after transplantation， and primary hydronephrosis may all suggest a higher risk of high-grade urothelial carcinoma after transplantation. Multivariate Logistic regression analysis showed that longer dialysis time before transplantation and high SII after transplantation were independent risk factors for highgrade urothelial carcinoma in patients with AAN after transplantation. The probability of disease was 〔-4.89+0.36× pretransplant dialysis time （month） +0.01×SII〕×100%. Internal verification results show that the accuracy of the model is high. Conclusion Early surgery and low SII should be maintained after surgery for kidney transplant patients with chronic renal insufficiency due to previous use of aristolochic acid， to reduce the incidence of high-grade uroepithelial carcinoma after transplantation. 

Key words:

Aristolochic acid nephropathy； , Allograft kidney transplantation； , Urothelial carcinoma

摘要：

目的 探究因既往服用含马兜铃酸的中药后出现慢性肾功能不全并进展至尿毒症期的患者，在同种异体肾移植术后出现高级别尿路上皮癌的相关危险因素，并建立其预测模型。方法 本研究共纳入自2003 年 1 月至 2025 年 1 月诊断为马兜铃酸肾病（aristolochic acids nephropathy，AAN）并于首都医科大学附属北京友谊医院行同种异体肾移植手术后出现尿路上皮癌（urothelial carcinoma，UC）的患者共 70 例，按其病理级别分为高级别尿路上皮癌组（HUC 组，共 55 例）和低级别尿路上皮癌组（LUC 组，共 15 例）。收集并对比两组患者的流行病学资料、移植后一般状态、肾积水情况、病毒感染情况等，采用 t 检验、Mann-Whitney 检验以及卡方检验探究导致出现高级别尿路上皮癌的危险因素，通过多元 Logistic 回归分析其独立危险因素进而得到预测模型，并通过内部验证证实该预测模型的准确性。结果 HUC 组及 LUC 组患者在性别、BMI、既往病史、出现尿路上皮癌时的肾小球滤过率（estimated glomerular filtration rate，eGFR）、肾移植到出现尿路上皮癌的时间、初次发现肿瘤的部位以及移植后免疫抑制方案等临床资料无统计学差异。但移植前透析时间较长、移植后系统性免疫炎症指数（systemic immune-inflammation index，SII）较高和原肾积水都可能提示较高的移植后高级别尿路上皮癌患病风险。多元 Logistic 回归分析显示，移植前透析时间较长和移植后高 SII 是 AAN 患者移植后罹患高级别尿路上皮癌的独立危险因素。其患病概率为〔-4.89+0.36× 移植前透析时间（月）+ 0.01×SII〕×100%。内部验证结果证实，该模型预测的准确率较高。结论 对于因既往服用马兜铃酸导致慢性肾功能不全并拟行同种异体肾移植手术的患者而言，应尽早手术，并在手术后维持低 SII，以降低移植后高级别尿路上皮癌的发生率。

关键词: 马兜铃酸肾病 , 同种异体肾移植 , 尿路上皮癌