肾移植术后红细胞增多症与高钙血症相关性的临床研究  

Clinical study on relationship between erythrocytosis and hypercalcemia in renal transplant recipients

作　　者：罗用文 钱叶勇 范宇 柏宏伟 常京元 王振 

机构地区：[1]解放军医学院,北京100853 [2]解放军第三○九医院 全军器官移植研究所泌尿二科

出　　处：《中华器官移植杂志》2015年第7期399-402,共4页Chinese Journal of Organ Transplantation

摘　　要：目的 分析与探讨肾移植术后红细胞增多症（PTE）与高钙血症的相关性.方法 回顾性分析2012年1月至2014年1月169例接受肾移植、且术后移植肾功能恢复正常受者的临床资料.169例受者中,男性121例,女性48例,所有受者均采用环孢素A（或他克莫司）＋吗替麦考酚酯＋醋酸泼尼松的三联免疫抑制方案,术后随访时间（20.1±15.9）个月.结果 随访期间,48例（28.4％）受者发生PTE,33例（19.5％）发生高钙血症.发生高钙血症受者中17例（51.5％）发生PTE,非高钙血症受者中31例（22.8％）发生PTE,二者的PTE发生率比较,差异有统计学意义（P＜0.001）,PTE与高钙血症具有相关性.PTE组受者的血钙水平为（2.46±0.1）mmol/L,显著高于非PTE组受者的（2.39±0.1）mmol/L（P=0.003）.PTE组受者高钙血症发生率为35.4％（17/48）,显著高于非PTE组的13.2％（16/121）,差异有统计学意义（P＜0.001）.简单线性回归模型分析结果显示,术后血钙离子浓度是血红蛋白水平的独立预测因子（P＜0.01）;多重线性回归模型分析结果显示,血钙离子浓度仍然是血红蛋白水平的显著预测因子（P＜0.001）;多因素Logistic回归模型分析结果显示,高钙血症是术后发生PTE的独立危险因素（相对危险系数=4.837,95％可信区间为1.447～16.173,P=0.01）,估算肾小球滤过率（eGFR）也与PTE发生相关（P=0.012）,而男性发生PTE的相对危险度为女性的4.373倍（P＜0.05）.高钙血症受者发生PTE的几率比血钙正常受者高大约5倍.结论 肾移植术后PTE与高钙血症存在明显的相关关系,高钙血症可能增加PTE的发生风险.Objective To examine the relationship between hypercalcemia （HC） and the development of posttransplant erythrocytosis （PTE）.Method 169 patients with normal graft function who underwent renal transplantation between January 1, 2012 and January 1, 2014 in 309th Hospital of PLA were retrospectively reviewed.Result 169 patients with normal graft function who underwent kidney transplantation for the first time in 309th Hospital from January 1, 2012 to January 1, 2014 were enrolled, including 121 males and 48 females.During the follow-up period, PTE appeared in 48 （28.4%） patients.Thirty-three （19.5%） patients developed HC, PTE occurred in 17/33 （51.5%） patients with HC, and in 31/136 （22.8%） patients without HC.PTE and HC were highly correlated （P〈0.001）.Serum calcium levels tended to increase in patients with PTE, but significantly decreased in patients without PTE.HC patients had a higher probability of PTE （51.5% vs.22.8%;P〈0.001）.Similarly, HC was more common among patients with PTE compared with patients without PTE （35.4% vs.13.2%;P〈0.001）.Simple linear regression analysis showed that calcium concentration was independent predictor of hemoglobin levels （P〈0.01）.In multivariate analysis, multiple linear regression model showed that the calcium concentration was still a significant predictor of hemoglobin levels （P〈0.001）.Multivariate logistic regression analysis showed that the occurrence of HC was an independent risk factor of PTE （P =0.01）.Estimated glomerular filtration rate was also associated with PTE （P =0.012）.As compared with women, the relative risk of men who had PTE was 4.373 times （P〈0.05）.The risk of PTE in patients with HC was about five times higher than in patients with normal blood calcium.Conclusion HC is associated with PTE.HC may lead to the increased PTE in renal transplant recipients.

关 键 词：肾移植 红细胞增多症 高钙血症 

分 类 号：R699.2[医药卫生—泌尿科学]