儿童肾移植后激素撤离保护策略的对照研究  

A control study of steroid withdrawal protection strategy after kidney transplantation in children

作　　者：卢洁仪 张妙 林金爱 陈焕如 李颖杰 高霞 王长希[2] 刘龙山[2] 廖欣 Lu Jieyi;Zhang Miao;Lin Jinai;Chen Huanru;Li Yingjie;Gao Xia;Wang Changxi;Liu Longshan;Liao Xin(Department of Nephology,Guangzhou Women and Children′s Medical Center,Guangzhou 510120,China;Department of Organ Transplantation,First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心肾内科,广州510120 [2]中山大学附属第一医院器官移植科,广州510120

出　　处：《中华儿科杂志》2023年第9期799-804,共6页Chinese Journal of Pediatrics

基　　金：广州市科学技术局科学研究计划 (201904010476)。

摘　　要：目的探讨糖皮质激素(GC)撤离保护策略对儿童肾移植术后身高生长的影响。方法前瞻性队列研究。以2017年7月至2022年9月由广州市妇女儿童医疗中心提供并已接受同种异体肾移植手术的40例慢性肾脏病5期患儿为研究对象,术前原发病免疫相关性肾小球疾病或病因不明的患儿为激素维持组,遗传性肾脏病或先天性泌尿系畸形的患儿为激素撤离组。激素维持组采用激素维持法,术后3个月内激素逐渐减量至低剂量(2.5~5.0 mg/d)维持。激素撤离组采用激素撤离法,术后3个月内激素逐渐减量至停药。在基线及移植后6、12、18、24个月记录两组患儿生长数据及临床资料。组间比较采用t检验、重复测量资料方差分析、Mann-Whitney U检验或Fisher确切概率法。结果40例患儿中男17例、女23例,激素撤离组25例[移植年龄(7.8±2.8)岁],激素维持组15例[移植年龄(7.6±3.5)岁],总体随访时间(26±12)个月。激素撤离组单位体重GC剂量明显低于激素维持组[(0.13±0.06)比(0.36±0.19)mg/(kg·d),t=5.83,P<0.001]。术后第1年激素撤离组身高追赶速率(ΔHtSDS)为1.0(0.7,1.4),激素维持组为0.4(0.1,1.0);第2年激素撤离组ΔHtSDS明显大于激素维持组[1.1(0.2,1.7)比0.3(0,0.8),U=28.00,P=0.039]。激素撤离和激素维持组在5个随访时间点之间的HtSDS分别为-2.5±0.8、-2.0±0.8、-1.5±0.8、-1.3±0.9、-0.5±0.3和-2.4±1.3、-2.2±1.1、-2.0±1.0、-1.8±1.0、-1.6±1.0,差异有统计学意义(F=19.81,P<0.01),但两组间HtSDS整体效应差异无统计学意义(F=1.13,P=0.204),激素的使用与随访时间的增加有交互作用(F=3.62,P=0.009)。在移植后第24个月,激素撤离组终点身高标准差积分明显高于激素维持组(t=2.13,P=0.047)。激素撤离组发生抗体介导性排斥反应(AMR)有6例,激素维持组有3例,两组AMR发生率差异无统计学意义(χ^(2)=0.06,P=0.814)。结论儿童肾移植后早期采取激素撤离保护策略有利于追赶性�Objective To study the influence of steroid withdrawal protection strategy on height growth in pediatric patients after kidney transplantation.Methods The prospective cohort study enrolled 40 stage 5 chronic kidney disease children receiving kidney transplantation from July 2017 to September 2022 at Guangzhou Women and Children′s Medical Center.Based on the primary preoperative disease,patients with immune abnormality-associated glomerular diseases or unknown causes were assigned to the steroid maintenance group,in which patients received steroid tapering within 3 months after surgery to a maintenance dose of 2.5 to 5.0 mg/d.While patients with hereditary kidney disease or congenital urinary malformations were assigned to the steroid withdrawal group,in which patients had steroids tapered off within 3 months.The characteristics of height catch-up growth and clinical data were compared between the 2 groups at baseline,6,12,18 and 24 months after kidney transplantation.T-test,repeated measurement of variance analysis,Mann-Whitney U test,and Fisher exact test were used for the comparison between the 2 groups.Results Among the 40 children,17 were males,23 were females,25 were in the steroid withdraw group((7.8±2.8)years old when receiving kidney transplantation)and 15 cases were in the steroid maintenance group((7.6±3.5)years old when receiving kidney transplantation).The study population was followed up for(26±12)months.The total dose per unit body weight of steroids in the steroid withdrawal group was lower than that in the steroid maintenance group((0.13±0.06)vs.(0.36±0.19)mg/(kg·d),t=5.83,P<0.001).The height catch-up rate(ΔHtSDS)in the first year after kidney transplantation in the steroid withdraw and steroid maintenance groups was 1.0(0.7,1.4)and 0.4(0.1,1.0),respectively;in the second year,theΔHtSDS in the steroid withdraw group was significantly higher than that in the steroid maintenance group(1.1(0.2,1.7)vs.0.3(0,0.8),U=28.00,P=0.039).The HtSDS in the steroid withdrawal group at the five follow-up

关 键 词：肾移植 免疫抑制 激素撤离 追赶性生长 儿童 

分 类 号：R726.9[医药卫生—儿科]