肾移植受者左室结构功能和血管钙化的评估及骨代谢对其的影响  

Evaluation of left ventricular structural and functional abnormalities and vascular calcification in kidney transplant recipients and the effect of bone metabolism on them

作　　者：孙黎[1] 韩志坚[1] 居小兵[1] 陶俊[1] 陈浩[1] 黄正楷[1] 王子杰[1] 费爽[1] 顾民[1] 谭若芸 Sun Li;Han Zhijian;Ju Xiaobing;Tao Jun;Chen Hao;Huang Zhengkai;Wang Zijie;Fei Shuang;Gu Min;Tan Ruoyun(Department of Urology and Nephrology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科肾移植中心,南京210029

出　　处：《中华器官移植杂志》2023年第4期214-222,共9页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金面上项目(82070769,82170769,81870512,81770751,81570676,81470981);国家自然科学基金青年基金项目(81900684)。

摘　　要：目的评估肾移植受者左心室结构功能和血管钙化情况,分析其影响因素及矿物质和骨代谢异常对其的影响。方法回顾性分析南京医科大学第一附属医院泌尿外科肾移植中心2017年1月至2019年12月间收治并获随访的292例肾移植受者,检测其骨代谢生化标志物、骨密度水平,评估左心室肥厚(left ventricular hypertrophy,LVH)、左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张功能、冠状动脉钙化(coronary artery calcification,CAC)积分、胸主动脉钙化(thoracic aortic calcification,TAC)积分。应用线性回归分析、二元Logistic回归分析评估心血管指标的影响因素及矿物质和骨代谢异常对其的影响。结果肾移植受者术后矿物质和骨代谢异常主要表现为高钙(calcium,Ca)26例(8.9%),低磷(phosphorus,P)79例(27.1%),低25羟基维生素D[25-hydroxyvitamin D,25(OH)vitD]196例(67.0%),甲状旁腺功能亢进148例(50.6%)。骨转换标志物升高,骨量丢失率约为25%~30%。LVH、LVEF<50%、左室舒张功能不全、高CAC积分、高TAC积分受者分别为116例(39.9%)、0、38例(13.1%)、50例(17.3%)、116例(39.9%)。多因素分析结果显示,LVH与受者高血压和血Ca呈正相关(95%CI:1.242~28.080,P=0.026;95%CI:1.714~277.584,P=0.018);LVEF与受者腰椎骨密度呈正相关(95%CI:0.0001~0.0055,P=0.041);左室舒张功能不全与受者年龄、糖尿病、甲状旁腺增生/结节呈正相关(95%CI:1.050~1.176,P<0.001;95%CI:2.118~43.813,P=0.003和95%CI:1.419~9.103,P=0.007);高CAC积分与受者年龄及透析时间呈正相关(95%CI:1.036~1.160,P=0.001和95%CI:1.009~1.041,P=0.002);高TAC积分与受者年龄呈正相关(95%CI:1.095~1.215,P<0.001)。并且相关性分析提示TAC与血Ca(r=0.233,P=0.003)、骨特异碱性磷酸酶(r=0.325,P<0.001)、Ⅰ型胶原交联N-末端肽(r=0.204,P=0.011)正相关,与股骨颈骨密度(r=0.194,P=0.017)负相关。结论肾移植受者左室结构功能异常及血管钙化患病率较高,矿物质和骨代�Objective To evaluate left ventricular structural and functional abnormalities and vascular calcification in kidney transplant(KT)recipients,explore their influencing factors and examine the effects of mineral and bone disorders.Methods From January 2017 to December 2019,retrospective analysis was performed for 292 KT recipients.Biochemical markers of bone metabolism,bone mineral density(BMD),left ventricular hypertrophy(LVH),left ventricular ejection fraction(LVEF),left ventricular diastolic function,coronary artery calcification(CAC)score and thoracic aortic calcification(TAC)score were assessed.Linear regression and binary Logistic regression analyses were employed for evaluating the influencing factors of cardiovascular parameters and the influence of abnormal mineral and bone metabolism.Results Postoperative abnormalities in mineral and bone disorders were manifested mostly as hypercalcemia(8.9%,26/292),hypophosphatemia(27.1%,79/292),low 25-hydroxyvitamin D(25(OH)vitD)(67.0%,196/292),hyperparathyroidismhigh parathyroid hormone(PTH)(50.6%,148/292),elevated bone turnover markers and bone loss rate of 25%-30%.The prevalence of LVH,LVEF<50%,left ventricular diastolic dysfunction,high CAC score and high TAC score were 39.9%(116/292),0%,13.1%(38/292),17.3%(50/292)and 39.9%(116/292)respectively.The results of multivariate analysis indicated that LVH was correlated positively with hypertension and serum calcium(Ca)(95%CI:1.242-28.080,P=0.026;95%CI:1.714-277.584,P=0.018);LVEF was correlated positively with lumbar vertebrae BMD(95%CI:0.0001-0.0055,P=0.041);Left ventricular diastolic dysfunction was correlated positively with age,diabetes and parathyroid hyperplasia/nodules(95%CI:1.050-1.176,P<0.001;95%CI:2.118-43.813,P=0.003 and 95%CI:1.419-9.103,P=0.007);High CAC score was correlated positively with recipient age and dialysis time(95%CI:1.036-1.160,P=0.001;95%CI:1.009-1.041,P=0.002);High TAC score was correlated positively with age(95%CI:1.095-1.215,P<0.001).Correlation analysis indicated that TAC was correlated posi

关 键 词：肾移植 矿物质和骨代谢异常 左心室结构及功能 血管钙化 

分 类 号：R699.2[医药卫生—泌尿科学]