Effect of internal iliac artery calcification on delayed graft function and short-term prognosis of kidney transplant recipients
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摘要:
目的 分析髂内动脉钙化与肾移植受者移植物功能延迟恢复(DGF)及近期预后的相关性。 方法 回顾性分析222例肾移植受者的临床资料。依据肾功能恢复情况分为DGF组(50例)和移植物功能正常恢复(IGF)组(172例),根据是否合并髂内动脉重度钙化将DGF组和IGF组分为DGF高危组(22例)、DGF低危组(28例)、IGF高危组(41例)以及IGF低危组(131例)。比较两组供受者临床资料,总结肾移植术后DGF及髂内动脉钙化发生情况,分析肾移植术后发生DGF的危险因素、髂内动脉钙化与临床指标的相关性以及DGF合并髂内动脉重度钙化受者近期预后。 结果 本研究中DGF发生率为22.5%(50/222)。肾移植受者中28.4%(63/222)合并髂内动脉重度钙化,DGF组中44%(22/50)合并髂内动脉重度钙化,高于IGF组中的23.8%(41/172)(P < 0.05)。单因素分析结果显示供者终末血清肌酐(Scr)高、男性供者,受者甘油三酯水平高和髂内动脉重度钙化是肾移植术后发生DGF的危险因素(均为P < 0.05)。多因素logistic回归分析显示供者Scr≥143 μmol/L及受者髂内动脉重度钙化是肾移植术后发生DGF的独立危险因素(均为P < 0.05)。相关性分析结果显示髂内动脉钙化与受者年龄和肾动脉吻合方式均呈弱相关(均为P < 0.05)。DGF组受者术后1个月的Scr高于IGF组,估算肾小球滤过率(eGFR)低于IGF组(均为P < 0.05);DGF高危组受者术后12个月的eGFR低于DGF低危组、IGF高危组以及IGF低危组(均为P < 0.05)。 结论 髂内动脉钙化不仅是影响移植肾功能恢复的危险因素,也对移植肾功能的近期预后造成不良影响。 Abstract:Objective To analyze the correlation between internal iliac artery calcification and delayed graft function (DGF) and short-term prognosis of kidney transplant recipients. Methods Clinical data of 222 kidney transplant recipients were retrospectively analyzed. According to the recovery of renal function, all recipients were divided into the DGF group (n=50) and immediate graft function (IGF) group (n=172). According to whether the recipients were complicated with severe internal iliac artery calcification, DGF and IGF groups were further divided into the high-risk DGF (n=22), low-risk DGF (n=28), high-risk IGF (n=41) and low-risk IGF(n=131) subgroups, respectively. Clinical data of donors and recipients were statistically compared between two groups. The incidences of postoperative DGF and internal iliac artery calcification were recorded. The risk factors of DGF after kidney transplantation, and the correlation between internal iliac artery calcification and clinical parameters were analyzed. Short-term prognosis of recipients with DGF complicated with severe internal iliac artery calcification was evaluated. Results The incidence of DGF was 22.5% (50/222). Among all recipients, 28.4% (63/222) were complicated with severe internal iliac artery calcification. In the DGF group, 44% (22/50) of the recipients were complicated with severe internal iliac artery calcification, higher than 23.8% (41/172) in the IGF group (P < 0.05). Univariate analysis showed that high serum creatinine (Scr) level of donors, male donor, high triglyceride level and severe internal iliac artery calcification of recipients were the risk factors for DGF after kidney transplantation (all P < 0.05). Multivariate logistic regression analysis revealed that Scr≥143 μmol/L of donors and severe internal iliac artery calcification of recipients were the independent risk factors for DGF after kidney transplantation (both P < 0.05). Correlation analysis indicated that internal iliac artery calcification was weakly correlated with the age of recipients and renal artery anastomosis (both P < 0.05). In the DGF group, the Scr level at postoperative 1 month was significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower than those in the IGF group (both P < 0.05). The eGFR at postoperative 12 months in the high-risk DGF subgroup was significantly lower than those in the low-risk DGF, high-risk IGF and low-risk IGF subgroups (all P < 0.05). Conclusions Internal iliac artery calcification is not only a risk factor for recovery of renal allograft function, but also negatively affects short-term prognosis of renal allograft function. -
表 1 肾移植术后发生DGF的危险因素单因素分析
Table 1. Univariate analysis of risk factors for DGF after kidney transplantation
变量 DGF组(n=50例) IGF组(n=172例) 统计值 P值 供者资料 年龄(x±s,岁) 41±11 39±13 0.10 0.42 性别[n(%)] 5.34 0.02 男 46(92) 133(77) 女 4(8) 39(23) Scr [M(P25, P75),μmol/L] 154(81,293) 86(58,129) -4.32 < 0.01 受者资料 年龄(x±s,岁) 43±11 43±10 0.80 0.92 性别[n(%)] 1.02 0.31 男 35(70) 107(62) 女 15(30) 65(38) BMI(x±s,kg/m2) 23±4 22±3 1.76 0.08 收缩压(x±s,mmHg) 144±23 151±19 -2.01 0.04 舒张压(x±s,mmHg) 92±15 98±13 -2.45 0.02 血糖(x±s,mmol/L) 5.4±1.7 5.4±2.2 -0.15 0.88 甘油三酯(x±s,mmol/L) 2.2±1.4 1.8±1.1 2.13 0.03 高密度脂蛋白(x±s,mmol/L) 1.0±0.4 1.1±0.4 -0.76 0.45 术前透析方式[n(%)] 1.79 0.41 血液透析 35(70) 110(64) 腹膜透析 15(30) 57(33) 无 0 5(3) 髂内动脉钙化程度[n(%)] 7.74 < 0.01 正常至中度 28(56) 131(76) 重度 22(44) 41(24) 手术资料 肾动脉吻合方式[n(%)] 2.26 0.32 髂内动脉 28(56) 112(65) 髂外动脉 16(32) 49(28) 髂内动脉合并髂外动脉 6(12) 11(6) 热缺血时间[M(P25, P75),min] 10(5,10) 10(5,10) -0.56 0.58 冷缺血时间[M(P25, P75),h] 12(6,18) 10(6,15) -1.12 0.26 HLA错配数[M(P25, P75),个] 3(2,4) 3(2,4) -1.84 0.07 免疫诱导方案[n(%)] 2.64 0.11 巴利昔单抗 32(64) 130(76) 兔抗人胸腺细胞免疫球蛋白 18(36) 42(24) 表 2 肾移植术后发生DGF的危险因素多因素分析
Table 2. Multivariate analysis of risk factors for DGF after kidney transplantation
变量 回归系数 标准误 Wald χ2值 OR 95%CI P值 供者Scr≥143 μmol/L 1.45 0.37 15.28 4.23 2.06~8.80 < 0.01 供者男性 1.00 0.62 2.64 2.72 0.81~9.07 0.10 受者BMI≥25 kg/m2 0.56 0.45 1.52 1.75 0.72~4.25 0.22 受者收缩压≥130 mmHg -1.33 0.52 6.61 0.27 0.10~0.73 0.01 受者舒张压≥85 mmHg 0.01 0.52 0.01 1.01 0.36~2.81 0.99 受者甘油三酯≥1.69 mmol/L 0.35 0.37 0.89 1.42 0.69~2.92 0.35 受者髂内动脉重度钙化 0.99 0.39 6.49 2.68 1.26~5.72 0.01 HLA错配≥3个 0.19 0.15 1.58 1.21 0.90~1.63 0.21 表 3 髂内动脉钙化与临床因素相关性分析
Table 3. Correlation analysis between internal iliac artery calcification and clinical factors
临床因素 χ2值 关联系数(λ) P值 性别 3.50 0.02 0.06 年龄 16.98 0.08 < 0.01 BMI 1.44 0.01 0.23 甘油三酯 4.80 0.01 0.31 糖尿病 0.36 < 0.01 0.55 高密度脂蛋白 0.40 < 0.01 0.53 收缩压 2.72 0.01 0.10 舒张压 0.43 < 0.01 0.71 肾动脉吻合方式 60.02 0.30 < 0.01 术前血液透析方式 3.13 0.01 0.28 表 4 DGF组与IGF组受者移植肾功能比较
Table 4. Comparison of renal graft function of recipients between DGF and IGF groups (x±s)
变量 DGF组(n=50) IGF组(n=172) t值 P值 Scr(μmol/L) 术后1个月 133±48 99±38 4.67 < 0.01 术后12个月 108±37 101±31 1.27 0.31 eGFR [mL/(min·1.73m2)] 术后1个月 51±24 76±24 -6.41 < 0.01 术后12个月 71±34 81±32 -1.91 0.06 表 5 4个亚组受者移植肾功能比较
Table 5. Comparison of renal graft function of recipients among 4 subgroups (x±s)
变量 DGF高危组(n=22) DGF低危组(n=28) IGF高危组(n=41) IGF低危组(n=131) F值 P值 Scr(μmol/L) 术后1个月 135±53a 132±45a 106±61 96±28 10.13 < 0.01 术后12个月 113±42 104±34 106±43 100±27 1.19 0.31 eGFR [mL/(min·1.73m2)] 术后1个月 48±24a, b 54±24a, b 77±25 76±24 13.86 < 0.01 术后12个月 58±28a, b, c 81±36 82±36 81±31 3.06 0.03 注:与IGF低危组比较,aP < 0.05;与IGF高危组比较,bP < 0.05;与DGF低危组比较,cP < 0.05。 -
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