Guidelines for clinical diagnosis and treatment of hypertension in kidney transplant recipients in China
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摘要: 为了进一步规范中国肾脏移植术后高血压的诊断和治疗，中华医学会器官移植学分会组织肾脏移植专家和心血管病专家，在《中国实体器官移植术后高血压诊疗规范（2019版）》的基础上，结合我国器官移植后高血压的临床现状，并参考近年国内外高血压最新诊治指南，从流行病学、诊断和治疗等方面，制定《中国肾脏移植受者高血压临床诊疗指南》，为中国肾脏移植领域医务工作者在术后高血压诊治方面提供理论借鉴和参考，以期更好地控制肾脏移植术后成人高血压，改善不良结局，提高生命质量。Abstract: To further standardize the diagnosis and treatment of hypertension after kidney transplantation in China, Branch of Organ Transplantation of Chinese Medical Association organized experts in kidney transplantation and cardiovascular diseases to formulate “Guidelines for Clinical Diagnosis and Treatment of Hypertension in Kidney Transplant Recipients in China” based on “Diagnosis and Treatment Specification for Hypertension after Solid Organ Transplantation in China (2019 edition)” in combination with clinical status of hypertension after organ transplantation in China, and referring to the latest guidelines for diagnosis and treatment of hypertension at home and abroad. This guideline was formulated to provide theoretical reference for medical practitioners in the field of kidney transplantation in China, aiming to better control adult hypertension after kidney transplantation, mitigate adverse outcomes and improve the quality of life.
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表 1 证据质量与推荐强度分级
Table 1. Level of evidence quality and recommended strength grades
推荐强度 证据等级 描述 A 1a RCT的系统评价 1b 结果可信区间小的RCT 1c 显示“全或无效应”的任何证据 B 2a 队列研究的系统评价 2b 单个队列研究（包括低质量的RCT，
如失访率>20%者）2c 基于患者结局的研究 3a 病例对照研究的系统评价 3b 单个病例对照研究 C 4 病例系列报告、低质量队列研究和
低质量病例对照研究D 5 专家意见（即无临床研究支持的仅依据
基础研究或临床经验的推测）
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表 2 高血压水平分类和定义
Table 2. Classification and definition of hypertension levels
分类 SBP（mmHg） 关系 DBP（mmHg） 理想血压 <120 和 <80 正常血压 120~129 和 80~84 正常高值血压 130~139 和（或） 85~89 1级高血压 140~159 和（或） 90~99 2级高血压 160~179 和（或） 100~109 3级高血压 ≥180 和（或） ≥110 单纯收缩期高血压 ≥140 和 <90 单纯舒张期高血压 <140 和 ≥90
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表 3 常用免疫抑制药导致移植术后高血压的相关机制
Table 3. The mechanism of commonly used immunosuppressants leading to postoperative hypertension after transplantation
类别 药物 机制 CNI 他克莫司、
环孢素提高血管张力：降低一氧化氮水平，升高内皮素水平，增加交感神经兴奋性；激活血管紧张素-
醛固酮系统：血压升高、水钠潴留；激活远端小管的钠-氯协同转运受体：钠重吸收增加，容量
过多；肾毒性：通过缩血管效应导致急性肾损伤；慢性缺血、肾小球硬化、致间质纤维化和萎缩mTORi 西罗莫司 代谢异常：血脂、血糖异常；致蛋白尿；增加额外的CVE风险 糖皮质激素 甲泼尼龙 增加交感神经兴奋性；增加血管张力；增加盐皮质激素活性
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表 4 肾脏移植术后高血压患者生活方式干预措施
Table 4. Lifestyle intervention measures for hypertensive patients after kidney transplantation
干预内容 目标 减少钠盐摄入、增加钾盐摄入 食盐摄入量<6 g/d，合并CKD患者食盐摄入量<5 g/d；肾功能正常者可适当补充钾盐 合理膳食 营养均衡 控制体质量 健康范围内，BMI 18.5～23.9 kg/m2，男性腰围<90 cm、女性腰围<85 cm[123] 戒烟 彻底戒烟，避免被动吸烟 限制饮酒 男性每日酒精摄入量≤25 g，女性每日酒精摄入量≤15 g；男性每周酒精摄入量≤140 g，
女性每周酒精摄入量≤80 g；建议戒酒适量体育运动 中等强度，每周150 min，或根据术后恢复情况，尽量达到与其心血管系统和
身体耐受性相适应的水平调整心理状态 减轻精神压力、保持心理平衡 管理睡眠 改善睡眠质量[124-125]
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