肾移植受者新发高甘油三酯血症的危险因素:单中心分析  

Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients:a single-center analysis

作　　者：徐媛 杨波 陈成鑫 朱科静 牛玉林 李海洋 Xu Yuan;Yang Bo;Chen Chengxin;Zhu Kejing;Niu Yulin;Li Haiyang(Department of Organ Transplantation,the Affiliated Hospital of Guizhou Medical University,Guiyang 550000,China)

机构地区：[1]贵州医科大学附属医院器官移植科,贵阳550000

出　　处：《器官移植》2023年第5期691-699,共9页Organ Transplantation

基　　金：贵州省基础研究计划项目(自然科学类)(黔科合基础-ZK[2023]一般376);贵州省卫生健康委科学技术基金项目(gzwkj2023-164)。

摘　　要：目的探讨肾移植受者新发高甘油三酯血症(HTG)的危险因素。方法回顾性分析149例肾移植受者的临床资料,根据术后血清甘油三酯(TG)水平,分为无HTG组(TG≤1.7 mmol/L,60例)与新发HTG组(TG>1.7 mmol/L,89例)。比较两组受者的一般资料,采用广义估计方程(GEE)分析肾移植受者发生HTG的危险因素,并应用多个回归方程验证。结果两组受者一般资料差异均无统计学意义(均为P>0.05)。多因素分析结果显示,与低浓度Tac组受者相比,中浓度Tac组和高浓度Tac组的HTG发生率升高[中浓度Tac组比值比(OR)3.11,95%可信区间(CI)1.22~7.93,P=0.018;高浓度Tac组OR5.11,95%CI1.31~19.98,P=0.019]。与A型血受者相比,O型血受者新发HTG的风险增加(OR 2.77,95%CI 1.14~6.71,P=0.024)。随着术前球蛋白水平升高,受者新发HTG的风险降低(OR 0.93,95%CI 0.87~0.99,P=0.043)。术后3个月时,新发HTG组Tac血药浓度高于无HTG组,差异有统计学意义(P<0.05)。多个回归方程验证了O型血肾移植受者较A型血受者新发HTG的风险增加,中浓度Tac组和高浓度Tac组肾移植受者较低浓度Tac组新发HTG的风险增加(均为P<0.05)。结论O型血肾移植受者更易发生HTG,加强血脂的术后监测和控制十分重要。Tac血药浓度对肾移植受者术后新发HTG可能存在一定影响,维持适宜血药浓度可能有利于降低HTG发生率。Objective To identify the risk factors of new-onset hypertriglyceridemia(HTG)in kidney transplant recipients.Methods Clinical data of 149 kidney transplant recipients were retrospectively analyzed.According to serum triglyceride(TG)level after operation,they were divided into the non-HTG group(TG≤1.7 mmol/L,n=60)and newonset HTG group(TG>1.7 mmol/L,n=89).Baseline data of all recipients were compared between two groups.The risk factors of HTG in kidney transplant recipients were analyzed by generalized estimating equation(GEE),and validated by multiple regression equations.Results No significant differences were observed in baseline data between two groups(all P>0.05).Multivariate analysis showed that the incidence of HTG in the middle and high tacrolimus(Tac)concentration groups was higher than that in the low Tac concentration group[odds ratio(OR)3.11,95%confidence interval(CI)1.22-7.93,P=0.018 in the middle Tac concentration group;OR 5.11,95%CI 1.31-19.98,P=0.019 in the high Tac concentration group].Compared with type-A blood recipients,the risk of new-onset HTG was significantly increased in type-O blood counterparts(OR 2.77,95%CI 1.14-6.71,P=0.024).The risk of new-onset HTG was decreased along with the increase of preoperative globulin level(OR 0.93,95%CI 0.87-0.99,P=0.043).At postoperative 3 months,Tac blood concentration in the new-onset HTG group was significantly higher compared with that in the non-HTG group,and significant difference was observed(P<0.05).Multiple regression equations confirmed that the risk of new-onset HTG in type-O blood kidney transplant recipients was higher than that in type-A blood counterparts,and the risk of new-onset HTG in the middle and high Tac concentration groups was higher than that in the low Tac concentration group(all P<0.05).Conclusions Type-O blood kidney transplant recipients are more prone to HTG.It is necessary to strengthen postoperative monitoring and control of blood lipids.The blood concentration of Tac probably affects the new-onset HTG in kidney transplant

关 键 词：肾移植 高甘油三酯血症 他克莫司 血型 危险因素 广义估计方程 哺乳动物雷帕霉素靶蛋白抑制剂 钙调磷酸酶抑制剂 

分 类 号：R617[医药卫生—外科学] Q493.5[医药卫生—临床医学]