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肾移植受者术前合并代谢综合征对早期移植肾功能的影响

唐永斌, 田子健, 张志鹏, 等. 肾移植受者术前合并代谢综合征对早期移植肾功能的影响[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024045
引用本文: 唐永斌, 田子健, 张志鹏, 等. 肾移植受者术前合并代谢综合征对早期移植肾功能的影响[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024045
Tang Yongbin, Tian Zijian, Zhang Zhipeng, et al. Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024045
Citation: Tang Yongbin, Tian Zijian, Zhang Zhipeng, et al. Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024045

肾移植受者术前合并代谢综合征对早期移植肾功能的影响

doi: 10.3969/j.issn.1674-7445.2024045
基金项目: 中央高水平医院临床科研业务费(BJ-2022-174)
详细信息
    作者简介:
    通讯作者:

    张亚群(ORCID 0000-0002-5332-6675),博士,主任医师,研究方向为肾移植,Email:zhangyqbjyy@126.com

  • 中图分类号: R617, R589

Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients

More Information
  • 摘要:   目的   探讨同种异体肾移植受者术前合并代谢综合征对早期移植肾功能的影响。  方法  回顾性分析117例肾移植受者的临床资料,根据移植肾功能分为移植物功能延迟恢复(DGF)组(29例)和非DGF组(88例),应用单因素和多因素回归分析同种异体肾移植受者发生DGF的相关危险因素,分析肾移植受者术前合并代谢综合征对早移植肾功能的影响。  结果  117例肾移植受者,47例术前合并代谢综合征,29例术后发生DGF,DGF组中83%术前合并代谢综合征,高于非DGF组中的74%(P<0.05)。单因素分析结果显示,DGF组供者体质量指数(BMI)、终末血清肌酐(Scr),受者术前BMI、血糖、甘油三酯水平、术前合并代谢综合征比例均高于非DGF组(均为P<0.05)。多因素logistic回归分析结果显示,供者Scr水平高、受者术前血红蛋白水平高、受者术前合并代谢综合征是肾移植术后发生DGF的独立危险因素(均为P<0.05)。  结论  受者术前合并代谢综合征是同种异体肾移植发生DGF的独立危险因素,应采取相关策略以减少DGF和其他与代谢相关的并发症的发生率。

     

  • 表  1  术前合并代谢综合征与不合并代谢综合征受者及其相应供者的一般情况比较

    Table  1.   Comparison of the general situation of recipients with and without preoperative metabolic syndrome and their corresponding donors

    变量 合并代谢综合征(n=47) 不合并代谢综合征(n=70) 统计值 P
    供者资料
     年龄($\overline x \pm s $,岁) 52±10 46±11 2.788 0.006
     性别[n(%)] 0.890 0.345
      男 43(91) 60(86)
      女 4(9) 10(14)
     BMI($\overline x \pm s $,kg/m2 24.7±3.1 23.6±3.6 1.722 0.088
     终末Scr[MP25,P75),μmol/L] 74(52,112) 51(35,68) 3.375 <0.001
    受者资料
     年龄($\overline x \pm s $,岁) 48±11 48±12 0.050 0.480
     性别[n(%)] 0.143 0.705
      男 37(79) 53(76)
      女 10(21) 17(24)
     术前BMI($\overline x \pm s $,kg/m2 25.6±2.6 22.8±2.6 5.656 <0.001
     术前收缩压($\overline x \pm s $,mmHg) 143±18 144±16 0.380 0.352
     术前舒张压($\overline x \pm s $,mmHg) 82±11 85±11 1.719 0.088
     术前血红蛋白($\overline x \pm s $,g/L) 108±16 111±20 0.635 0.527
     术前白蛋白($\overline x \pm s $,g/L) 41±6 43±5 1.960 0.052
     术前血糖($\overline x \pm s $,mmol/L) 7.2±2.5 5.3±1.4 4.736 <0.001
     术前Scr($\overline x \pm s $,μmol/L] 919±248 858±292 1.183 0.239
     术前尿酸[MP25,P75),mmol/L] 384(298,444) 356(274,421) 1.318 0.188
     术前甘油三酯[MP25,P75),mmol/L] 2.3(1.8,3.8) 1.3(1.0,1.6) 6.419 <0.001
     术前高密度脂蛋白[MP25,P75),mmol/L) 0.8(0.7,1.0) 1.2(1.1,1.4) 6.300 <0.001
     术前透析方式[n(%)] 0.760 0.766
      未透析 7(15) 7(10)
      血液透析 32(68) 49(70)
      腹膜透析 8(17) 14(20)
     术前透析时间[MP25,P75),月] 11(4,24) 11(3,24) 0.234 0.815
     肾动脉吻合方式[n(%)] 0.515
      髂外动脉 47(100) 68(97)
      髂内动脉 0 2(3)
     冷缺血时间[MP25,P75),h] 6(5,9) 6(5,8) 0.862 0.388
    下载: 导出CSV

    表  2  肾移植术后发生DGF危险因素的单因素分析

    Table  2.   Univariate analysis of risk factors for DGF after kidney transplantation

    变量 DGF组(n=29) 非DGF组(n=88) 统计值 P
    供者资料
     年龄 51±12 48±11 1.531 0.128
     性别[n(%)] 0.184
      男 28(97) 75(85)
      女 1(3) 13(15)
     BMI($\overline x \pm s $,kg/m2 25.3±2.1 23.6±3.7 2.430 0.017
     终末Scr[MP25,P75),μmol/L] 98(75,166) 50(36,66) 6.093 <0.001
    受者资料
     年龄($\overline x \pm s $,岁) 46±10 49±11 1.394 0.166
     性别[n(%)] 2.826 0.093
      男 19(66) 71(81)
      女 10(34) 17(19)
     术前BMI($\overline x \pm s $,kg/m2 25.0±3.0 23.6±2.8 2.397 0.018
     术前收缩压($\overline x \pm s $,mmHg) 139±15 145±17 1.480 0.142
     术前舒张压($\overline x \pm s $,mmHg) 82±11 84±11 1.144 0.255
     术前血红蛋白($\overline x \pm s $,g/L) 115±16 108±19 1.848 0.067
     术前白蛋白($\overline x \pm s $,g/L) 41±7 42±5 0.765 0.449
    术前血糖($\overline x \pm s $,mmol/L) 7.2±2.7 5.6±1.8 2.836 <0.001
     术前Scr[MP25,P75),μmol/L] 888±287 881±274 0.130 0.897
     术前尿酸[MP25,P75),mmol/L] 383(298,436) 378(282,435) 0.341 0.733
     术前甘油三酯[MP25,P75),mmol/L] 2.3(1.5,3.6) 1.4(1.2,1.8) 3.213 0.001
     术前高密度脂蛋白[MP25,P75),mmol/L] 1.0(0.7,1.3) 1.1(0.9,1.3) 1.708 0.088
     术前透析方式[n(%)] 0.035
      未透析 4(14) 10(11)
      血液透析 24(83) 57(65)
      腹膜透析 1(3) 21(24)
     术前透析时间[MP25,P75),月] 12(5,24) 11(3,24) 0.468 0.640
     肾动脉吻合方式[n(%)] 1.000
      髂外动脉 29(100) 86(98)
      髂内动脉 0 2(2)
     冷缺血时间[MP25,P75),h] 6(5,9) 6(5,8) 0.629 0.529
     术前合并代谢综合征[n(%)] 29.097 <0.001
      是 24(83) 65(74)
      否 5(17) 23(26)
    下载: 导出CSV

    表  3  肾移植术后发生DGF危险因素的多因素分析

    Table  3.   Multivariate analysis of risk factors for DGF after kidney transplantation

    变量 回归系数 标准误 Wald χ2 比值比 95%可信区间 P
    供者终末Scr 0.014 0.005 7.107 1.014 1.004~1.024 0.008
    受者术前血红蛋白 0.042 0.018 5.192 1.043 1.006~1.081 0.023
    受者术前合并代谢综合征 2.836 0.672 17.794 17.048 4.565~63.67 <0.001
    下载: 导出CSV

    表  4  2组受者术后早期移植肾功能比较

    Table  4.   Comparison of renal graft function of recipients in the early postoperative period between 2 groups [MP25,P75)]

    变量 合并代谢综合征(n=47) 不合并代谢综合征(n=70) 检验值 P
    Scr(μmol/L)
     术后1 d 683(497,878) 550(414,669) 2.824 0.005
     术后2 d 433(262,838)a 282(199,392)a 3.761 <0.001
     术后3 d 287(165,651)a,b 174(127,271)a,b 3.953 <0.001
    eGFR[mL/(min·1.73m2)]
     术后1 d 6.66(5.00,9.78) 8.61(6.20,12.13) 2.924 0.003
     术后2 d 11.40(5.61,22.58)a 19.96(12.67,31.43)a 3.725 <0.001
     术后3 d 18.88(7.73,37.48)a,b 34.81(20.69,53.47)a,b 3.947 <0.001
      注:与术后1 d比较,aP<0.05/3;与术后2 d比较,bP<0.05/3。
    下载: 导出CSV
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