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髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响

惠宇, 胡林昆, 周政, 等. 髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响[J]. 器官移植, 2023, 14(2): 265-272. doi: 10.3969/j.issn.1674-7445.2023.02.013
引用本文: 惠宇, 胡林昆, 周政, 等. 髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响[J]. 器官移植, 2023, 14(2): 265-272. doi: 10.3969/j.issn.1674-7445.2023.02.013
Hui Yu, Hu Linkun, Zhou Zheng, et al. Effect of internal iliac artery calcification on delayed graft function and short-term prognosis of kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 265-272. doi: 10.3969/j.issn.1674-7445.2023.02.013
Citation: Hui Yu, Hu Linkun, Zhou Zheng, et al. Effect of internal iliac artery calcification on delayed graft function and short-term prognosis of kidney transplant recipients[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 265-272. doi: 10.3969/j.issn.1674-7445.2023.02.013

髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响

doi: 10.3969/j.issn.1674-7445.2023.02.013
基金项目: 

国家自然科学基金 82270787

苏州市科技计划项目 SYS2019052

详细信息
    作者简介:
    通讯作者:

    胡林昆,博士,副主任医师,研究方向为肾移植,Email:hulinkunsz@163.com

    魏雪栋,博士,副主任医师,研究方向为肾移植,Email:wxd0422@hotmail.com

  • 中图分类号: R617, R692

Effect of internal iliac artery calcification on delayed graft function and short-term prognosis of kidney transplant recipients

More Information
  • 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。

     

  • 图  1  1例患者髂内动脉钙化轴位与冠状位的CT影像

    注:A图为轴位面;B图为冠状位面。箭头标记为髂内动脉钙化。

    Figure  1.  Axial and coronal CT images of internal iliac artery calcification in one patient

    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
    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 [MP25, 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[MP25, P75),min] 10(5,10) 10(5,10) -0.56 0.58
      冷缺血时间[MP25, P75),h] 12(6,18) 10(6,15) -1.12 0.26
      HLA错配数[MP25, 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)
    下载: 导出CSV

    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 OR 95%CI P
    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
    下载: 导出CSV

    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 关联系数(λ P
    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
    下载: 导出CSV

    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 P
    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
    下载: 导出CSV

    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 P
    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。
    下载: 导出CSV
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  • 收稿日期:  2022-10-18
  • 网络出版日期:  2023-03-15
  • 刊出日期:  2023-03-15

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