程序性死亡受体 1 抑制剂对肿瘤患者急性肾损伤发生及远期肾功能的影响

doi:10.3969/j.issn.1006-298X.2026.03.005

肾脏病与透析肾移植杂志 ›› 2026, Vol. 35 ›› Issue (3): 229-234.DOI: 10.3969/j.issn.1006-298X.2026.03.005

程序性死亡受体 1 抑制剂对肿瘤患者急性肾损伤发生及远期肾功能的影响

出版日期:2026-06-29 发布日期:2026-07-02

Programmed death-1inhibitors on the occurrence of acute kidney injury and long-term renal function in cancer patients

Online:2026-06-29 Published:2026-07-02

摘要/Abstract

摘要： 目的：探讨程序性死亡受体1(PD-1)抑制剂联合化疗对肿瘤患者急性肾损伤(AKI)发生率及远期肾功能的影响。方法：采用回顾性队列研究，收集2018年1月至2024年12月住院治疗的311例肿瘤患者临床资料。根据治疗方案将患者分为联合治疗组(PD-1抑制剂联合化疗)和单纯化疗组(单用化疗)。收集基线及治疗后的临床资料，并记录1个月、3个月、6个月、12个月的估算肾小球滤过率(eGFR)下降和AKI发生率。采用线性混合模型分析eGFR随时间的变化趋势，Kaplan-Meier法评估AKI发生及eGFR下降的累积发生率，Cox比例风险模型分析影响肾功能结局的关联因素。结果：(1)联合治疗组AKI发生率(14.7% vs 5.4%)及eGFR下降发生率(41.1% vs 25.0%)均高于单纯化疗组。(2)生存分析显示，联合治疗组未发生AKI的患者比例、未发生eGFR下降的患者比例均显著低于单纯化疗组；多因素Cox回归分析表明，使用 PD-1抑制剂、较高的基线尿素水平是eGFR下降的独立危险因素；而使用PD-1抑制剂亦是AKI发生的独立风险因素 (HR=3.60)。(3)线性混合模型显示，随访期间两组eGFR水平均呈下降趋势，且联合治疗组下降更明显(P=0.018)。结论：与单纯化疗相比，联合使用 PD-1 抑制剂与肿瘤患者 AKI 发生风险增加及 eGFR 下降显著相关。

关键词: 程序性死亡受体 1 抑制剂, 恶性肿瘤, 肾功能, 急性肾损伤, 肾小球滤过率

Abstract: Objective: To explore the effects of programmed death-1 (PD-1) inhibitor combined with chemotherapy versus chemotherapy alone on the incidence of acute kidney injury (AKI) and long-term renal function in tumor patients.

Methods: A retrospective cohort study was conducted. Clinical data were collected from 311 hospitalized tumor patients between January 2018 and December 2024. Patients were divided into the combination therapy group and the chemotherapy-alone group according to the treatment regimen. Baseline and post-treatment clinical data were collected, and the decline rate of estimated glomerular filtration rate (eGFR) and incidence of AKI were recorded at the 1st, 3rd, 6th and 12th months after treatment initiation. The incidence of eGFR decline and AKI at each time point were recorded. A linear mixed model was adopted to analyze the changing trend of eGFR over time. The Kaplan-Meier method was used to assess the cumulative incidence of AKI and eGFR decline, and the Cox proportional hazards model was applied to analyze the related factors affecting renal function outcomes.

Results: (1) The incidence of AKI (14.7% vs 5.4%) and eGFR decline (41.1% vs 25.0%) in the combination therapy group were significantly higher than those in the chemotherapy-alone group. (2) Survival analysis showed that the proportions of patients without AKI and without eGFR decline in the combination therapy group were significantly lower than those in the chemotherapy-alone group. Multivariate Cox regression analysis revealed that PD-1 inhibitor use and elevated baseline urea level were independent risk factors for eGFR decline; additionally, PD-1 inhibitor use was an independent risk factor for AKI occurrence (HR = 3.60, 95%CI 1.53–8.44). (3) The linear mixed model revealed that eGFR levels decreased in both groups during follow-up, with a statistically significant difference in the declining trend. The reduction was more pronounced in the combined treatment group (P = 0.018).

Conclusion: Compared with chemotherapy alone, the combined application of PD-1 inhibitors is significantly correlated with an increased risk of AKI and eGFR decline in tumor patients.

中图分类号:

何静, 王阳, 杨舒立, 吴舜, 耿欣, 王瑞, 王岩, 董青, 洪思雯, 刘亚, 任红旗. 程序性死亡受体 1 抑制剂对肿瘤患者急性肾损伤发生及远期肾功能的影响[J]. 肾脏病与透析肾移植杂志, 2026, 35(3): 229-234.

HE Jing, WANG Yang, YANG Shuli, WU Shun, GENG Xin, WANG Rui, WANG Yan, DONG Qing, HONG Siwen, LIU Ya, REN Hongqi. Programmed death-1inhibitors on the occurrence of acute kidney injury and long-term renal function in cancer patients[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2026, 35(3): 229-234.

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ISSN 1006-298X CN 32-1425/R

程序性死亡受体 1 抑制剂对肿瘤患者急性肾损伤发生及远期肾功能的影响

Programmed death-1inhibitors on the occurrence of acute kidney injury and long-term renal function in cancer patients

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