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

    摘要
  • 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OR 5.11，95%CI 1.31～19.98，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。

     

    Abstract:
      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 new-onset 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 recipients. Maintaining an appropriate blood concentration of Tac may be beneficial to lowering the risk of HTG.

     

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