肾移植术后移植肾局灶性节段性肾小球硬化临床分析  

Focal segmental glomerulosclerosis in renal allografts: clinical analysis of a single institution

作　　者：黎东伟[1] 曹海明[1] 熊韫祎[1] 费继光[1] 邓素雄[1] 黄刚[1] 王长希[1] 

机构地区：[1]中山大学附属第一医院器官移植科,广州510080

出　　处：《中华移植杂志（电子版）》2015年第2期14-17,共4页Chinese Journal of Transplantation(Electronic Edition)

基　　金：广东省科技计划项目(2009B030801145)

摘　　要：目的分析肾移植术后发生移植肾局灶性节段性肾小球硬化(FSGS)患者的临床和病理特征。方法回顾性分析中山大学附属第一医院器官移植科2009年3月至2012年3月经移植肾穿刺活检确诊为FSGS的25例肾移植受者资料。根据FSGS患者预后分为好转组、未愈组和恶化组,分析3组患者在年龄、性别、伴发病、发病时间、活检时间、基础免疫抑制方案、穿刺时24 h尿蛋白定量、穿刺时血清肌酐水平、硬化肾小球百分比等方面是否存在差异,分析蛋白尿水平和肾功能不全程度与肾小球硬化程度的相关关系。两个连续型随机变量的关联性分析采用Pearson相关分析及Spearman秩相关分析,多组定量资料比较采用方差分析或Kruskal-Wallis秩和检验;多组定性资料比较采用χ2检验或Fisher确切概率法。结果好转组、未愈组、恶化组患者性别、年龄、伴发病(高血压和高脂血症)、发病时间(肾移植术后至FSGS发病的时间)、活检时间(FSGS发病至移植肾活检时的时间)、基础免疫抑制方案以及24 h尿蛋白定量差异均无统计学意义(P均>0.05)。好转组、未愈组、恶化组患者穿刺时血清肌酐水平分别为(144±47)、(232±103)、(410±208)μmol/L,硬化肾小球百分比分别为(0.24±0.19)%、(0.56±0.23)%、(0.49±0.26)%,差异均有统计学意义(F=6.33和4.01,P均<0.05)。25例肾移植术后FSGS患者尿蛋白定量与穿刺时血肌酐水平无明显相关(r=-0.019,P>0.05);尿蛋白定量与肾小球硬化程度无明显相关(r=0.316,P>0.05)。结论移植肾FSGS临床表现与原发FSGS相似,治疗困难,预后较差。移植后出现蛋白尿早期,应及时进行移植肾活检并给予相应治疗。Objective To analyze the clinical and pathological features of focal segmental glomerulosclerosis（ FSGS） in renal allografts after renal transplantation. Methods Twenty-five renal transplant recipients who were diagnosed as FSGS in the First Affiliated Hospital of Sun Yat-sen University from March 2009 to March 2012 were retrospectively analyzed. The severity of FSGS was quantified,and the correlation of proteinuria and renal insufficiency with glomerulosclerosis was determined. Patients were divided into an ＂improvement ＂ group,a ＂no change ＂ group,and a＂deterioration＂ group. Age,gender,concomitant diseases,time of disease onset,time of renal allograft biopsy,immunosuppressive protocols,urinary protein level within 24 hours,serum creatinine level,and severity of glomerulosclerosis at the time of biopsy were analyzed in three groups. Results In 25 patients of renal allograft FSGS,urinary proteinuria levels were not significantly related to serum creatinine levels（ r =- 0. 019,P = 0. 929） or the severity of glomerulosclerosis（ r = 0. 316,P =0. 124）. The three groups had significant differences in serum creatinine levels（ F = 6. 33,P〈0. 005）and severity of glomerulosclerosis（ F = 4. 01,P〈0. 05） at the time of biopsy,but didn＇ t have significant differences in immunosuppressive protocol or any other measured factors. Conclusions Theclinical and pathological features of FSGS in renal allograft is similar with that of non-transplant people.The prognosis of FSGS in renal allograft is generally poor due to its difficult treatment. Early biopsy diagnosis and management of FSGS in allografts may improve the patient＇s survival.

关 键 词：肾移植 局灶性节段性肾小球硬化 蛋白尿 活检 临床分析 

分 类 号：R699.2[医药卫生—泌尿科学]