肾移植受者术后早期血脂异常的趋势——北京地区多中心调查分析  

Tendency of dyslipidemia in the early stage after renal transplantation： multicenter investigation in Beijing region

作　　者：马麟麟[1] 敖建华[2] 马潞林[3] 蔡明[4] 肖序仁 杨志豪[6] 曲星柯[7] 纪志刚[8] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿科,100050 [2]解放军总医院泌尿科 [3]北京大学第三医院泌尿科 [4]解放军总参谋部医院泌尿科 [5]武装警察部队总医院泌尿科 [6]卫生部中日友好医院泌尿科 [7]北京大学人民医院泌尿科 [8]中国医学科学院协和医院泌尿科

出　　处：《中华器官移植杂志》2010年第5期269-272,共4页Chinese Journal of Organ Transplantation

摘　　要：目的了解肾移植受者术后早期血脂异常的趋势、相关发病因素及其对移植肾功能的影响。方法收集2004--2008年间在北京地区8所医院肾移植中心接受。肾移植的1032例临床资料，分析术前以及术后1、3、6和12个月的血总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）的变化趋势，按时间段分层分析不同阶段、不同年龄组血脂异常的差异，免疫抑制剂对血脂的影响，以及血脂异常对血肌酐的影响。结果除HDI』IC以外，其他3项在第1年中均呈现逐渐升高的趋势，尤以LDL-C和TG升高最为突出，TC和LDL-C异常与年龄有明显相关性（P〈0．01）。他克莫司为基础的免疫抑制方案对脂代谢异常的影响小于环孢素A（P〈0．05）。1年时降脂治疗与未治疗者之间血肌酐的差异无统计学意义（P〉0．05）；在未经降脂治疗的受者中，术后1个月TG高于正常者，其1年时的血肌酐明显高于TG正常者（P〈0．05）。结论肾移植受者术后血脂异常较为常见，个别指标术后1个月时即升高，并持续至1年；血脂异常与年龄呈正相关；以他克莫司为基础的免疫抑制剂组合对血脂的影响较小。Objective To investigate the current dyslipidemia profiles and correlation with etiological factors in early stage post-transplantation, and the impact of lipid metabolic disorder on renal function. Methods The clinical data of 1032 renal allografts from eight hospitals in Beijing between 2004 and 2008 were collected and evaluated retrospectively. Before and at the 1st, 3rd, 6th and 12th month post-transplantation, the changes in blood total cholesterol （TC）, triglycerides （TG）, low density lipoprotein （LDL）-cholesterol and high density lipoprotein （HDL）-cholesterol were analyzed. The difference in the blood lipid disorder at different stages stratified by time and different age group, the effects of immunosuppressive agents on blood lipid, and the impact of blood lipid disorder on the blood creatinine were studied. Results Except HDL-cholesterol, TC, LDL- cholesterol and TG levels were increased gradually at the first year, especially LDL-cholesterol and TG. The TC and LDL-cholesterol abnormalities were obviously related with age （P〈0. 01）. The effect of Tacrolimus （Tac）-based immunosuppressive regimen on the lipid metabolic disorder was less than cyclosporine （CsA）. At the first year, there was no significant difference in blood creatinine between lipid-lowering treatment and non-lipid-lowering treatment （P〉0. 05）. For the recipients not subject to lipid-lowering treatment and their TG level higher than the normal at the first month after operation, the creatinine level at the first year was significantly higher than in those with normal TG level （P〈0. 05）. Conclusion The lipid metabolic disorder following renal transplantation is a common complication after the first transplant year, and was related with age and immunosuppressive agent regimen. Tac-based immunosuppressive regimen has little effects on the blood lipid metabolism.

关 键 词：肾移植 脂代谢障碍 胆固醇 胆固醇 LDL 胆固醇 HDL 甘油三酯类 

分 类 号：R699.2[医药卫生—泌尿科学]