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肾移植术后肠道并发症临床诊治分析

杨其顺 姜伟 黄赤兵

杨其顺, 姜伟, 黄赤兵. 肾移植术后肠道并发症临床诊治分析[J]. 器官移植, 2018, 9(3): 215-221. doi: 10.3969/j.issn.1674-7445.2018.03.009
引用本文: 杨其顺, 姜伟, 黄赤兵. 肾移植术后肠道并发症临床诊治分析[J]. 器官移植, 2018, 9(3): 215-221. doi: 10.3969/j.issn.1674-7445.2018.03.009
Yang Qishun, Jiang Wei, Huang Chibing. Clinical diagnosis and treatment of intestinal complications after renal transplantation[J]. ORGAN TRANSPLANTATION, 2018, 9(3): 215-221. doi: 10.3969/j.issn.1674-7445.2018.03.009
Citation: Yang Qishun, Jiang Wei, Huang Chibing. Clinical diagnosis and treatment of intestinal complications after renal transplantation[J]. ORGAN TRANSPLANTATION, 2018, 9(3): 215-221. doi: 10.3969/j.issn.1674-7445.2018.03.009

肾移植术后肠道并发症临床诊治分析

doi: 10.3969/j.issn.1674-7445.2018.03.009
基金项目: 

国家自然科学基金 81570675

秦皇岛市科技计划项目 201602A237

详细信息
    作者简介:

    杨其顺,男,1981年生,第三军大学在职硕士研究生,主治医师,研究方向为肾移植,Email:yangqishun.good@163.com

    通讯作者:

    姜伟,男,1965年生,主任医师,研究方向为肾移植,Email:jiangwei281@163.com

    黄赤兵,男,1963年生,博士,博士研究生导师,主任医师,研究方向为肾移植,Email:huangchibing@medmail.com.cn

  • 中图分类号: R617, R574

Clinical diagnosis and treatment of intestinal complications after renal transplantation

More Information
  • 摘要: 目的 探讨肾移植术后肠道并发症的病因诱因、临床特点及诊治方案。 方法 回顾性分析47例肾移植术后肠道并发症患者的临床资料,总结其发病病因诱因、临床特点及治疗经验。 结果 肾移植术后肠道并发症患者47例,随访3~36个月(中位时间18个月),并发症包括上消化道出血4例,下消化道出血1例,急性肠炎25例,慢性肠炎12例,肠结核1例,结肠癌1例,肠梗阻3例。消化道出血患者中,4例发生在大剂量使用肾上腺皮质激素后,2例出现出血性休克。急性肠炎患者中,7例在肾移植围手术期首次服用免疫抑制剂,余18例有不洁饮食或着凉史,4例检测病原菌阳性。慢性肠炎患者中,12例麦考酚酸或他克莫司血药浓度升高,水、电解质、酸碱失衡,2例病原菌阳性,8例伴重度贫血。1例肠梗阻发生在肾移植围手术期,2例出现中毒性休克。根据疾病类型及病情严重程度,分别积极实施对症及病因治疗。47例患者中,45例治愈,2例死亡,死因分别为下消化道出血和结肠癌肺转移引起呼吸衰竭,3例出现移植肾功能不全。 结论 肾移植术后肠道并发症表现多样,与肠道稳态失衡有关,病情有急有缓,均可对移植肾功能造成不同程度的损害,合并严重并发症时预后不良,为降低其发生率,提高治愈率,积极预防和果断处理十分重要。

     

  • [1] 刘小伟, 孙瑞娟, 董尔丹, 等.肠道稳态及相关疾病研究现状与趋势[J].生理科学进展, 2013, 44(3): 206-212. DOI: 10.3969/j.issn.0559-7765.2013.03.010.

    LIU XW, SUN RJ, DONG ED, et al. Present situation and tendency of gut homeostasis and related disease research[J]. Prog Physiol Sci, 2013, 44(3): 206-212. DOI: 10.3969/j.issn.0559-7765.2013.03.010.
    [2] 陈润泽, 解傲.肠道稳态与代谢综合征[J].中国微生态学杂志, 2016, 28(1): 121-122. DOI: 10.13381/j.cnki.cjm.201601031.

    CHEN RZ, XIE A. Gut homeostasis and metabolic syndrome[J].Chin J Microecol, 2016, 28(1): 121-122. DOI: 10.13381/j.cnki.cjm.201601031.
    [3] 赵玉沛, 吕毅.消化系统疾病[M].北京:人民卫生出版社, 2016.
    [4] SELLIN JH. The pathophysiology of diarrhea[J]. Clin Transplant, 2001, 15(Suppl 4): 2-10.
    [5] 蒙龙, 陈永飞, 张晋萍, 等.糖皮质激素引起的严重消化道并发症及其预防[J].中国临床药理学与治疗学, 2013, 18(5):596-600. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zglcylxyzlx201305023

    MENG L, CHEN YF, ZHANG JP, et al. Glucocorticoidinduced gastrointestinal complications and prophylaxis[J]. Chin J Clin Pharmacol Therap, 2013, 18(5): 596-600. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zglcylxyzlx201305023
    [6] 秦荣良, 张更, 邵晨, 等.肾移植术后早期消化道出血的危险因素分析及治疗[J].现代泌尿外科杂志, 2010, 15(3): 216-218, 231. DOI: 10.3969/j.issn.1009-8291.

    2010.03.019. QIN RL, ZHANG G, SHAO C, et al. Risk factors analysis and treatment of gastrointestinal hemorrhage in early stage of kidney transplantations[J]. J Mod Urol, 2010, 15(3): 216-218, 231. DOI: 10.3969/j.issn.1009-8291.2010.03.019.
    [7] 滕立臣, 王长希, 陈立中, 等.腹泻对肾移植受者他可莫司血药浓度的影响[J].肾脏病与透析肾移植杂志, 2009, 18(5): 406-409, 437. DOI: 10.3969/j.issn.1006-298X.2009.05.002.

    TENG LC, WANG CX, CHEN LZ, et a1. Effect of diarrhea on tacrolimus blood trough levels in kidney transplantation recipients[J]. Chin J Nephrol Dial Transplant, 2009, 18(5): 406-409, 437. DOI: 10.3969/j.issn.1006-298X.2009.05.002.j.issn.1006-298X.2009.05.002.
    [8] 李智斌, 张更, 刘克普, 等.肾移植术后慢性腹泻的临床诊治分析[J].器官移植, 2015, 6(3): 184-189. DOI: 10.3969/j.issn.1674-7445.2015.03.011.

    LI ZB, ZHANG G, LIU KP, et a1. Clinical diagnosis and treatment of chronic diarrhea after renal transplantation[J]. Organ Transplant, 2015, 6(3): 184-189. DOI: 10.3969/j.issn.1674-7445.2015.03.011.
    [9] PESCOVITZ MD, NAVARRO MT. Immunosuppressive therapy and post-transplantation diarrhea[J]. Clin Transplant, 2001, 15 (Suppl 4): 23-28. DOI: 10.1111/j.1399-0012.2001.00023.x.
    [10] 孙雯, 郭宏波, 解泽林, 等.肾移植患者术后腹泻的相关因素分析[J].北京大学学报(医学版), 2013, 45(5): 779-781. DOI: 10.3969/j.issn.1671-167X.2013.05.025.

    SUN W, GUO HB, XIE ZL, et al. Association factors analysis of diarrhea in patients receiving kidney transplantation[J]. J Peking Univ(Health Sci), 2013, 45(5): 779-781. DOI: 10.3969/j.issn.1671-167X.2013.05.025.
    [11] DANGO S, BEIßBARTH T, WEISS E, et al. et al. Relevance of surgery in patients with non-variceal upper gastrointestinal bleeding[J]. Langenbecks Arch Surg, 2017, 402(3):509-519. DOI: 10.1007/s00423-017-1552-2.
    [12] HAGEL AF, ALBRECHT H, NÄGEL A, et al. The application of hemospray in gastrointestinal bleeding during emergency endoscopy[J]. Gastroenterol Res Pract, 2017: 3083481. DOI: 10.1155/2017/3083481.
    [13] 朱勇, 李丽, 张跃新.细菌感染性腹泻216例临床及病原学特点[J].世界华人消化杂志, 2017, 25(2): 190-193. http://kns.cnki.net/KCMS/detail/detail.aspx?filename=xxhb201702018&dbname=CJFD&dbcode=CJFQ

    ZHU Y, LI L, ZHANG YX. Clinical and etiological characteristics of bacterial infectious diarrhea: analysis of 216 cases[J]. World Chin J Dig, 2017, 25(2): 190-193. http://kns.cnki.net/KCMS/detail/detail.aspx?filename=xxhb201702018&dbname=CJFD&dbcode=CJFQ
    [14] CALMET FH, YARUR AJ, PUKAZHENDHI G, et al. Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation[J]. Ann Gastroenterol, 2015, 28(3): 366-373. https://www.researchgate.net/publication/279729291_Endoscopic_and_histological_features_of_mycophenolate_mofetil_colitis_in_patients_after_solid_organ_transplantation
    [15] BRAGA TT, CORREA-COSTA M, SILVA RC, et al. CCR2 contributes to the recruitment of monocytes and leads to kidney inflammation and fibrosis development[J]. Inflammopharmacology, 2018, 26(2): 403-411. DOI: 10.1007/s10787-017-0317-4.
    [16] 刘志威, 王学群, 李甜甜, 等.溃疡性结肠炎患者肠道菌群变化的临床意义[J].胃肠病学和肝病学杂志, 2016, 25(5): 554-556. DOI: 10.3969/j.issn.1006-5709. 2016.05.018.

    LIU ZW, WANG XQ, LI TT, et al. The clinical significance of intestinal flora changes in patients with ulcerative colitis[J]. Chin J Gastroenterol Hepatol, 2016, 25(5): 554-556. DOI: 10.3969/j.issn.1006-5709. 2016.05.018.j.issn.1006-5709.2016.05.018.
    [17] 张迎娣, 张红杰.肠道菌群在肠道稳态和炎症性肠病中的研究进展[J].胃肠病学, 2015, 20(3): 184-187. DOI: 10.3969/j.issn.1008-7125.2015.03.012.

    ZHANG YD, ZHANG HJ. Advances in study on intestinal microbiota in intestinal homeostasis and inflammatory bowel disease[J]. Chin J Gastroenterol, 2015, 20(3): 184-187. DOI: 10.3969/j.issn.1008-7125.2015.03.012.
    [18] NATIVIDAD JM, PETIT V, HUANG X, et al. Commensal and probiotic bacteria influence intestinal barrier function and susceptibility to colitisin Nod1-/-; Nod2-/-mice[J]. Inflamm Bowel Dis, 2012, 18(8): 1434-1446. DOI: 10.1002/ibd.22848.
    [19] LOREA BAROJA M, KIRJAVAINEN PV, HEKMAT S, et al. Anti-inflammatory effects of probiotic yogurt in inflammatory bowel disease patients[J]. Clin Exp Immunol, 2007, 149(3): 470-479. DOI: 10.1111/j.1365-2249.2007.03434.x
    [20] 朱兰, 王筱啸, 李娟, 等.长期服用五酯胶囊减少他克莫司剂量对肾移植受者他克莫司药动学的影响[J].中华器官移植杂志, 2014, 35(9): 533-536. DOI: 10.3760/cma.j.issn.0254-1785. 2014.09.006.

    ZHU L, WANG XX, LI J, et al. Parmacokinetic study of tacrolimus in renal transplant patients with Wuzhi capsule to decrease the bioavailability of tacrolimus[J]. Chin J Organ Transplant, 2014, 35(9): 533-536. DOI: 10.3760/cma.j.issn.0254-1785. 2014.09.006.cma.j.issn.0254-1785.2014.09.006.
    [21] CHOLONGITAS E, MAMOU C, RODRÍGUEZCASTRO KI, et al. Mammalian target of rapamycin inhibitors are associated with lower rates of hepatocellular carcinoma recurrence after liver transplantation: a systematic review[J]. Transpl Int, 2014, 27(10): 1039-1049. DOI: 10.1111/tri.12372.
    [22] TREAT E, BASKIN A, LIN A, et al. Use of polyethylene glycol electrolyte solution expedites return of bowel function and facilitates early discharge after kidney transplantation[J]. J Am Coll Surg, 2016, 222(5): 798-804. DOI: 10.1016/j.jamcollsurg.2016.01.058.
    [23] ALMUEILO SH, ALSULAIMAN RM. Acute colonic pseudo-obstruction caused by mycophenolate mofetil in a kidney transplant recipient[J]. Exp Clin Transplant, 2015, 13(2): 196-199. DOI: 10.6002/ect.2013.0264.
    [24] 张鑫, 王立明.肾移植术后肠梗阻并肝功能损伤患者应用他克莫司静脉维持治疗1例报告[J].第二军医大学学报, 2011, 32(3): 348. DOI: 10.3724/SP.J.1008.2011.00348.

    ZHANG X, WANG LM. Intravenous prograf in maintenance treatment of intestinal obstruction complicated with hepatic function injury after renal transplantation: a case report[J]. Acad J Second Mil Med Univ, 2011, 32(3): 348. DOI: 10.3724/SP.J.1008.2011.00348.
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出版历程
  • 收稿日期:  2018-01-20
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2018-05-15

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