移植术前零点穿刺Remuzzi高评分单供肾移植的临床观察  

Clinical observation of single kidney transplantation with high pathological Remuzzi score in zero-point biopsy

作　　者：李立志 孙平平 贾志缃 杨浩森 王卫 王佳丽 周华 陈好雨 Li Lizhi;Sun Pingping;Jia Zhixiang;Yang Haosen;Wang Wei;Wang Jiali;Zhou Hua;Chen Haoyu(Center of Kidney Transplantation&Dialysis,Second People’s Hospital of Shanxi Province,Shanxi Taiyuan 030012,China.)

机构地区：[1]山西省第二人民医院肾移植透析中心,山西太原030012

出　　处：《实用器官移植电子杂志》2025年第2期130-135,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：山西省卫生健康委员会课题(2022038)。

摘　　要：目的观察移植肾零点穿刺Remuzzi高评分的单供肾移植的疗效及生存情况。方法回顾性分析2018年1月至2021年1月于山西省第二人民医院行公民逝世后器官捐献供者单供肾移植的受者178例。供肾均行零点穿刺,并行病理Remuzzi评分,分为高评分组(≥4分且≤6分)和低评分组(≤3分)。随访36个月,观察两组术后移植肾延迟恢复发生情况,术后肾功能、蛋白尿发生情况,受者和移植肾存活情况。结果两组受者性别比例、体重指数、人类白细胞抗原(human leukocyte antigen,HLA)错配数、供肾冷缺血时间等无统计学差异(P>0.05),术前血肌酐及肾小球滤过率无统计学差异(P>0.05)。高评分组术后有21(23.6%)例出现延迟恢复,低评分组有6例(6.7%)出现延迟恢复,两组之间差异有统计学意义(P<0.05)。高评分组术后有24例(27%)出现蛋白尿,低评分组有9例(10.1%)出现蛋白尿,行多因素分析,显示与术前Remuzzi评分(OR=1.46,P<0.05)及术后加用mTOR类免疫抑制剂(OR=4.52,P<0.05)有关。高评分组随访36个月时血肌酐为(131.3±5.53)μmol/L、eGFR为(62.9±2.02)ml/(min·1.73 m2),低评分组血肌酐为(121.3±2.18)μmol/L、eGFR为(65.0±1.24)ml/(min·1.73 m2),两组之间差异无统计学意义(P>0.05)。术后36个月高评分组受者存活率为95.5%(85例),移植肾存活率95.5%(85例),低评分组受者存活率为95.5%(85例),移植肾存活率为97.7%(87例),差异无统计学意义(P>0.05)。结论移植前供肾活检6分≥Remuzzi≥4分的高评分行单供肾移植,可以取得良好的长期肾存活效果,值得临床开展。Objective To observe the efficacy and survival status of single donor kidney transplantation with high Remuzzi score at zero-point biopsy.Methods A retrospective analysis was conducted on 178 recipients of single donor kidney transplantation who received deceased organ donation at the Second People's Hospital of Shanxi Province from January 2018 to January 2021.The donor kidneys underwent zeropoint biopsies and were evaluated with pathological Remuzzi scoring.The recipients were divided into high scoring group(≥4 and≤6)and low scoring group(≤3).The occurrence of delayed graft function of transplanted kidneys,postoperative renal function,occurrence of proteinuria,and survival of recipients and transplanted kidneys in both groups were observed with a follow-up time of 36 months.Results There were no statistically significant differences(P>0.05)in gender ratio,body mass index,human leukocyte antigen(HLA)mismatch number,and donor kidney cold ischemia time between the two groups of recipients;there was no statistically significant difference in baseline blood creatinine and glomerular filtration rate before surgery(P>0.05).A total number of 21 cases(23.6%)in the high scoring group experienced delayed graft function of transplanted kidneys after surgery,while 6 cases(6.7%)in the low scoring group experienced delayed graft function.The difference between the two groups was statistically significant(P<0.05),24 cases(27%)in the high scoring group developed proteinuria after surgery,while 9 cases(10.1%)developed proteinuria in the low scoring group.Through multiple factor analysis,it was found that the occurrence of proteinuria after kidney transplantation and the addition of mTOR immunosuppressants after surgery(OR=4.52,P<0.05)were related to the preoperative Remuzzi score(OR=1.46,P<0.05).At a follow-up of 36 months,the high scoring group had a blood creatinine level of(131.3±5.53)μmol/L and an eGFR level of(62.9±2.02)ml/(min·1.73 m2),while the low scoring group had a blood creatinine level of(121.3±2.18)μmol/

关 键 词：Remuzzi评分 移植肾病理 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]