肾移植后血清尿酸水平对移植肾功能及长期存活的影响  

Effect of serum uric acid levels on graft function and long-term graft survival after kidney transplantation

作　　者：王明睿[1] 位海建 连鑫[1] 王钢[1] 高宝山[1] 周洪澜[1] 傅耀文[1] 

机构地区：[1]吉林大学第一医院,长春130021

出　　处：《中华器官移植杂志》2016年第12期742-747,共6页Chinese Journal of Organ Transplantation

基　　金：吉林省科技发展计划资助项目（20160101100JC）

摘　　要：目的研究肾移植术后血清尿酸水平对移植肾功能及长期存活的影响。方法回顾性研究2008年1月至2014年5月间859例接受同种异体肾移植者的临床资料。分析基于血清尿酸水平进行分组的尿酸正常组与高尿酸血症组患者临床指标的差异，Cox回归模型分析血清尿酸升高对总体移植肾功能丧失、移植肾功能丧失（除外移植肾有功能受者死亡）及受者死亡的影响。Kaplan-Meier生存曲线比较尿酸正常组与高尿酸血症组受者总体移植肾存活率、移植肾存活率（除外移植肾有功能受者死亡）及受者生存率的差异。结果859例肾移植受者随访时间为（38.6±17.3）个月。590例（68.7%）被纳入尿酸正常组，269例（31.3%）被纳入高尿酸血症组。与尿酸正常组相比较，高尿酸血症组术后eGFR显著降低，分别为（94.7±20.6） ml·min^－1·1.73 m^－2和（79.4±20.9） ml·min^－1·1.73 m^－2（P〈0.001）。Cox回归模型分析显示，血清尿酸水平每升高10 μmol/L，总体移植肾功能丧失的风险升高1.070倍（P〈0.001），除外移植肾有功能受者死亡的移植肾功能丧失风险升高1.121倍（P〈0.001）。Kaplan-Meier生存分析表明，与尿酸正常组受者相比，高尿酸血症组总体移植肾存活率显著降低（P＝0.009）。高尿酸血症组移植肾存活率（除外移植肾有功能受者死亡）较尿酸正常组显著降低（P〈0.0001）。而两组移植后受者存活率的差异无统计学意义（P＝0.638）。结论肾移植术后血清尿酸水平对移植肾功能及长期存活有影响。ObjectiveTo study the effect of serum uric acid （UA） levels on kidney graft function as well as long-term graft survival after renal transplantation.MethodsThe clinical data of 859 kidney transplant recipients from Jan. 2008 to May 2014 were investigated retrospectively. The differences in clinical indexes between normal UA group and hyperuricemia group were compared based on UA levels. Cox regression model was built to analyze the effect of elevated UA on overall graft loss, death censored graft failure and death of patients, respectively. Kaplan-Meier graft survival curve was used to compare the overall graft loss, death censored graft failure and death of patients between normal UA group and hyperuricemia group.ResultsThe average follow-up time was 38.6±17.3 months for 859 kidney transplant recipients. 590 （68.7%） recipients were enrolled in normal UA group and 269 （31.3%） recipients were defined as hyperuricemia patients. The average eGFR in hyperuricemia group was significantly decreased as compared with normal UA group （79.4±20.93 vs. 94.7±20.55, P〈0.001）. Cox regression model showed that if UA level increased per 10 mol/L, the risk of overall graft lost increased 1.070 times （P〈0.001） and the risk of death censored graft failure increased 1.121 times （P〈0.001） accordingly. Kaplan-Meier analysis showed the overall graft loss was dramatically decreased （P=0.009）, and the death censored graft failure was significantly decreased （P〈0.0001） in hyperuricemia group as compared with that in normal UA group. The death of patients showed no significant difference between two groups （P=0.638）.ConclusionSerum UA levels after kidney transplantation affect graft function as well as long-term graft survival.

关 键 词：肾移植 移植肾存活 高尿酸血症 

分 类 号：R699[医药卫生—泌尿科学]