成人肝移植后远期高尿酸血症及肾损害的治疗27例  

Long-term post-liver-transplantation hyperuricemia and treatment of renal function damage： Report of 27 adult cases

作　　者：陈池义 蒋文涛[2] 张骊[1] 田大治[1] 郭庆军[1] 李俊杰[1] 

机构地区：[1]天津医科大学一中心临床学院,300070 [2]天津市第一中心医院肝移植科

出　　处：《中华器官移植杂志》2016年第7期411-414,共4页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（863计划）（2012AA021006）;天津市卫生局攻关课题（13KG101）;国家卫生与计划生育委员会课题（201302009）

摘　　要：目的探讨成人肝移植后远期高尿酸血症及降尿酸治疗对受者肾功能的影响。方法从2011年3月至2013年12月的428例肝移植病例中选取随访超过1年的受者206例为研究对象，根据受者术后超过1年的两次非同日血尿酸浓度（SUA），将男性SUA〉420μmol／L、女性SUA〉360μmol／L定义为高尿酸血症（HUA）组，其余为非HUA组，回顾分析两组间SUA峰值所对应的血肌酐（sCr）及估算肾小球滤过率（eGFR）有无差异；其中HUA合并肾功能异常的27例受者接受降尿酸治疗后，分析其肾功能指标血肌酐及eGFR在治疗前后有无差异。结果49．5％的受者肝移植术后远期出现HuA。与非HuA组比较，HuA组受者的血肌酐较高，差异有统计学意义（P〈0．05）；HUA组受者的eGI、R较低，差异有统计学意义（P〈0．05）；HUA组中27例受者经过时间中位数为8周的降尿酸治疗后，有24例（88．9％，24／27）SUA恢复正常，有21例（77．8％，21／27）血肌酐值不同程度下降。受者的SUA水平由（532．94±93．91）μmol／L下降至（349．93±22．85）μmol／L（P〈0．001），血肌酐水平由（144．95±13．51）μmol／L下降至（129．52±19．06）μmol／L（P=0．016）；eGFR由（46．46±8．11）ml·min-1·1．73m-2上升至（56．30±11．46）ml·min-1·1．73m-2（P=0．012），肾功能得到一定程度改善。结论HUA是成人肝移植术后远期常见并发症，可以对受者的肾功能造成不利影响，需予以重视，在排除其他因的素影响后，降尿酸治疗可能有助于改善肾功能。Objective To study long-term post-liver-transplantation hyperuricemia （HUA） and the influence of urate-lowering therapyon renal functions of adult patients. Methods Among 428 cases undergoing liver transplantations during March 2011 to December 2013, 206 patients, whose follow- up periods were above 1 year, were selected as the objects of study. Those whose two-time serum uric acid （SUA） levels tested not in the same day one year after operation 〉420 μmol/L （male）, or female 〉360 μmol/L （female） were divided into HUA group, and non-HUA group. The serum creatinine （SCr） concentrations and glomerular filtration rate （eOFR） were analyzedin the two groups at their peak SUA to find whether there was any difference between the two groups. Meanwhile, 27 HUA patients with abnormal renal function were given urate-lowering therapy and the differences in SCr and eGFR after the therapy were observed. Results 49. 5% patients sufferedlong-term HUA after liver transplantations. As compared with non-HUA group, SCrconcentrations were increased statistically （P〈0. 05）, and eGFR was reduced statistically in HUA group （P〈0. 05）. After 8-week urate- lowering therapy among 27 patients, SUA level in 24 cases （88. 9%, 24/27） returned to the normal standard and SCr concentrations in 21 cases （77. 8%, 21/27） decreased for a certain degree. SUA levels were decreased to （349. 93 ± 22. 85） μmol/L from （532. 94 ± 93.91）μmol/L （P〈0. 001）. SCr concentrations were decreased to （129. 52 ± 19. 06）/μmol/L from （144. 95± 13. 51） μmol/L （P = 0.016）.The eGFR increased to （56. 30± 11.46） ml. min-1 1.73 m-2 from （46. 46 ±8.11） ml.min-1 1.73 m-2（P = 0. 012）, which showed a certain degree of improvement in their renal functions. Conclusion HUA is a long-term common complication in liver transplanted adult patients, which has a negative influence on patients renal functions, so we need to pay enough attention to this. Urate-lowing therapy has a positive influ

关 键 词：肝移植术后 高尿酸血症 肾功能 远期预后 

分 类 号：R657.3[医药卫生—外科学]