代谢综合征对移植肾功能延迟恢复及预后的影响  

Effect of metabolic syndrome on delayed graft function and prognosis of patients with allograft renal transplantation

作　　者：戴天增 黄雪梅 方潇 刘向深 杨顺良[2] 蔡锦全[2] 王栋[2] 吴卫真[2] DAI Tianzeng;HUANG Xuemei;FANG Xiao;LIU Xiangshen;YANG Shunliang;CAI Jinquan;WANG Dong;WU Weizhen(Fuzhou Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of Urology,900th Hospital of Joint Logistics Support Force,Fujian Medical College,Fuzhou 350001,China;Department of Gastroenterology,Fujian Provincial Hospital,Fujian Medical College,Fuzhou 350001,China;Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学福总临床医学院,福州350001 [2]中国人民解放军联勤保障部队第九OO医院泌尿外科 [3]福建医科大学省立临床医学院 [4]福建医科大学孟超肝胆医院

出　　处：《肾脏病与透析肾移植杂志》2022年第1期45-51,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：福建省临床重点专科建设项目([2019]739)。

摘　　要：目的:分析代谢综合征(Mets)与肾移植术后移植肾功能延迟恢复(DGF)及患者预后的相关性。方法:回顾性分析2011年5月至2019年10月在中国人民解放军联勤保障部队第九OO医院接受同种异体肾移植手术的415例患者的临床资料。根据是否合并DGF将患者分为DGF组和非DGF组,分析两组病例供者年龄、死因、BMI、终末血清肌酐(SCr),受者性别、年龄、移植肾体积/体表面积(RV/BSA)、冷缺血时间(CIT)、热缺血时间(WIT)、合并乙型肝炎、体质量指数(BMI)、糖尿病、高脂血症、高血压、Mets等因素与术后DGF的关系及对患者预后的影响。结果:单因素分析提示供者死因、终末SCr、CIT、WIT、性别、糖尿病、高脂血症、BMI、合并Mets是肾移植术后并发DGF的危险因素(P<0.05);将单因素有统计学意义的指标纳入多因素logistic回归分析,结果提示供者终末SCr(OR=4.520,95%CI 2.585~7.904,P<0.001),CIT(OR=2.530,95%CI 1.273~5.028,P=0.008)、WIT(OR=2.249,95%CI 1.302~3.887,P=0.004),高血脂(OR=2.165,95%CI 1.078~4.348,P=0.030)和Mets(OR=7.393,95%CI 2.243~24.368,P=0.001)是肾移植术后并发DGF的独立危险因素;通过单因素、多因素Cox回归分析提示供者终末SCr(HR=2.269,95%CI 1.128~4.564,P=0.022)、CIT(HR=2.082,95%CI 1.007~4.308,P=0.048)、Mets(HR=5.744,95%CI 1.215~27.153,P=0.027)是移植肾失活的独立危险因素;合并Mets的患者肾移植术后并发肾结石、切口愈合不良、肺部感染风险更高。结论:合并Mets的患者肾移植术后并发DGF的风险明显增高,移植肾失功以及肾结石、切口愈合不良、肺部感染等并发症发生率增加。Objective:Analyze the relationship between metabolic syndrome(Mets)and delayed graft function(DGF),and prognosis of patients after renal transplantation.Methodology:A retrospective analysis of the clinical data of 415 patients who underwent allograft renal transplantation at the 900 th Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army from May 2011 to October 2019.The patients were divided into DGF group and non-DGF group relationship among the age of the donor,cause of death,BMI,terminal SCr,gender,age,transplanted kidney volume/body surface area(RV/BSA),cold ischemia time(CIT),warm ischemia time(WIT),hepatitis B,BMI,diabetes,hyperlipidemia,hypertension,Mets and postoperative DGF and its impact on the prognosis of the recipients were analyzed.Results:Univariate analysis suggested that cause of death,terminal SCr,cold ischemia time,warm ischemia time,gender,diabetes,hyperlipidemia,BMI,and Mets were risk factors for DGF after renal transplantation(P<0.05);single factor analysis results which had statistical significance were included in multivariate logistic regression analysis,and the results suggested that terminal SCr(OR=4.520,95%CI 2.585~7.904,P<0.001),CIT(OR=2.530,95%CI 1.273~5.028,P=0.008),WIT(OR=2.249,95%CI 1.302~3.887,P=0.004),hyperlipidemia(OR=2.165,95%CI 1.078~4.348,P=0.030)and Mets(OR=7.393,95%CI 2.243~24.368,P=0.001)were independent risk factors for DGF after renal transplantation;univariate and multivariate Cox regression analysis suggested that terminal SCr(HR=2.269,95%CI 1.128~4.564,P=0.022),CIT(HR=2.082,95%CI 1.007~4.308,P=0.048),Mets(HR=5.744,95%CI 1.215~27.153,P=0.027)were independent risk factors for renal allograft loss;preoperative patients combined Mets with were more likely to be complicated by kidney stones,poor incision healing,and lung infections.Conclusion:Patients with Mets had a significantly increased risk of DGF and worse prognosis after kidney transplantation.

关 键 词：代谢综合征 同种异体肾移植术后 移植肾功能延迟恢复 危险因素 预后 

分 类 号：R699.2[医药卫生—泌尿科学]