儿童肾移植术后激素撤除对生长曲线的影响  

Effect of glucocorticoids withdrawal on growth curve after pediatric renal transplantation

作　　者：胡明尧 尚文俊[1] 丰永花[1] 朱昆仑 张鲁予 王志刚[1] 王军祥[1] 谢红昌[1] 丰贵文[1] Hu Mingyao;Shang Wenjun;Feng Yonhua;Zhu Kunlun;Zhang Luyu;Wang Zhigang;Wang junxiang;Xie Hongchang;Feng Guiwen(Department of Kidney Transplantation,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾移植科,郑州450052

出　　处：《临床小儿外科杂志》2022年第5期415-419,共5页Journal of Clinical Pediatric Surgery

基　　金：河南省省部共建重点项目(SB201901004)。

摘　　要：目的探究儿童肾移植术后生长趋势以及激素撤除对于生长曲线的影响。方法回顾性分析2013年5月至2021年3月于郑州大学第一附属医院肾移植科接受肾移植手术的儿童受者临床资料,术后采用他克莫司+霉酚酸+糖皮质激素(glucocorticoid,GC)三联免疫治疗方案,根据术后3个月内是否撤除激素分为撤激素组和未撤激素组,观察两组各时间段内生长发育变化情况,比较两组在撤除激素前后各时间段生长变化速率的差异。结果共214例患儿纳入研究,其中未撤激素组142例,撤激素组72例;两组术前身高年龄别评分(height for age Z-score,HAZ评分)分别为(-1.60±1.48)分和(-1.44±1.38)分,差异无统计学意义(P=0.539);术后1年时两组HAZ评分分别为(-0.95±1.31)分和(-0.51±1.10)分,差异具有统计学意义(P=0.046)。两组术前、术后3个月、术后6个月的HAZ评分差异均无统计学意义(P>0.05)。两组手术后前3个月、手术后3~6个月HAZ评分的变化速率差异均无统计学意义(P>0.05),而手术后6~12个月的差异具有统计学意义(P=0.016)。结论慢性终末期肾病(end-stage renal disease,ESRD)患儿术前存在不同程度的发育迟缓,接受肾移植后患儿生长缺陷有所弥补,术后不同时间段身高发育速率有所不同,在术后追赶性生长的高峰期到来之前撤除激素对于儿童手术后远期发育有积极的影响。Objective To explore the trend of growth and development of children after renal transplantation and examine the effect of hormone withdrawal on growth curve.Methods From May 2013 to March 2021,a retrospective analysis was performed for clinical data of 214 children undergoing renal transplantation.According to whether or not hormone withdrawing within 3 months after surgery,it was divided into two groups of hormone withdrawal(n=142)and non-withdrawal(n=72).The curve of growth and development were compared between two groups before and after hormone withdrawal.Results Preoperative height for age Z-score(HAZ)was(-1.60±1.48)and(-1.44±1.38)without statistical difference(P=0.539).At Year 1 post-operation,HAZ was(-0.95±1.31)and(-0.51±1.10).And the difference was statistically significant(P=0.046).After renal transplantation,no inter-group difference existed in ΔHAZ before hormone withdrawal.The trend of ΔHAZ in hormone withdrawal group was higher than that in hormone non-withdrawal group within 3-6 months[(0.124±0.158)vs.(0.083±0.123),P=0.069]and it was also significantly higher in hormone withdrawal group than that in hormone non-withdrawal group at 6 months(P=0.016).Conclusion Children with end-stage renal disease(ESRD)have varying degrees of developmental delay before surgery.After renal transplantation,most defects become compensated.And rate of height development varies at different timepoints.Withdrawal of hormones before a peak of postoperative catch-up growth has a positive effect on long-term development of postoperative children.

关 键 词：肾移植 免疫抑制法 糖皮质激素类 生长激素 慢性终末期肾病 生长障碍 生长图表 对比研究 儿童 

分 类 号：R726.9[医药卫生—儿科]