Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients: a single-center analysis
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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. -
图 1 不同Tac浓度组及不同时间点Tac血药浓度与HTG的关系
注：A图为不同Tac浓度组受者HTG发生情况比较；B图为新发HTG受者不同时间点Tac血药浓度比较。与无HTG组比较，aP<0.05。
Figure 1. The relationship between Tac blood concentration and HTG in different Tac concentration groups and different time points
表 1 肾移植术后发生HTG的危险因素单因素分析
Table 1. Univariate analysis of risk factors for incidence of HTG after kidney transplantation
变量 无HTG组
（n=60）新发HTG组
（n=89）统计值 P值 年龄（$\bar x $±s，岁） 42±12 41±11 0.600 0.550 性别[n（%）] 0.220 0.639 男 41（68） 64（72） 女 19（32） 25（28） 民族[n（%）] 0.409 0.522 汉族 54（90） 77（87） 少数民族 6（10） 12（13） BMI（$\bar x $±s，kg/m2） 22±3 23±4 −1.070 0.286 是否贵州常住人口[n（%）] 0.043 0.836 否 10（17） 16（18） 是 50（83） 73（82） 透析方式[n（%）] 1.200 0.548 血液透析 44（73） 67（75） 腹膜透析 9（15） 16（18） 未透析 7（12） 6（7） 透析时间[M（P25, P75），月] 12（8，45） 12（8，36） 0.410 0.659 是否二次移植[n（%）] 1.735 0.188 否 54（90） 85（96） 是 6（10） 4（4） 高血压史[n（%）] 3.015 0.083 否 23（38） 47（53） 是 37（62） 42（47） 糖尿病史[n（%）] 3.706 0.054 否 51（85） 84（94） 是 9（15） 5（6） 输血史[n（%）] 1.568 0.210 否 41（68） 69（78） 是 19（32） 20（22） 吸烟史[n（%）] 0.739 0.390 否 45（75） 72（81） 是 15（25） 17（19） 饮酒史[n（%）] 1.719 0.190 否 47（78） 77（87） 是 13（22） 12（13） ABO血型[n（%）] 6.080 0.108 A型 24（40） 21（24） B型 15（25） 20（22） O型 19（32） 43（48） AB型 2（3） 5（6） Tac血药浓度[n（%）] 5.070 0.079 低浓度 15（25） 10（11） 中浓度 39（65） 66（74） 高浓度 6（10） 13（15） 术前白蛋白（$\bar x $±s，g/L） 45±5 44±6 0.560 0.573 术前球蛋白（$\bar x $±s，g/L） 28±5 26±6 1.670 0.097 术前血糖（$\bar x $±s，mmol/L） 4.7±1.9 4.5±1.2 0.920 0.358 术前TG[M（P25, P75），mmol/L] 1.5（0.8，1.8） 1.5（1.1，2.2） 0.420 0.677 术前胆固醇（$\bar x $±s，mmol/L） 4.0±1.4 4.2±1.1 −1.280 0.201 术前低密度脂蛋白（$\bar x $±s，mmol/L） 2.3±1.1 2.6±0.9 −1.480 0.139 
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表 2 肾移植术后发生HTG的危险因素多因素分析
Table 2. Multivariate analysis of risk factors for incidence of HTG after kidney transplantation
变量 估计值 标准误 Wald χ2值 OR值 95%CI P值 截距值 1.01 1.01 0.99 2.73 0.38～19.95 0.321 Tac血药浓度 低浓度 参考值 中浓度 1.13 0.48 5.64 3.11 1.22～7.93 0.018 高浓度 1.63 0.70 5.49 5.11 1.31～19.98 0.019 ABO血型 A型 参考值 B型 0.59 0.49 1.41 1.80 0.68～4.72 0.235 O型 1.02 0.45 5.08 2.77 1.14～6.71 0.024 AB型 1.17 0.92 1.62 3.21 0.53～19.30 0.203 术前球蛋白 −0.07 0.03 4.09 0.93 0.87～0.99 0.043 二次移植 −0.57 0.67 0.70 0.57 0.15～2.13 0.401 高血压史 −0.42 0.39 1.16 0.66 0.31～1.41 0.282 糖尿病史 −0.43 0.70 0.38 0.65 0.16～2.56 0.536 饮酒史 −0.31 0.49 0.38 0.73 0.28～1.94 0.536
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表 3 多个回归方程验证结果
Table 3. Verification result of multiple regression equation
未调整模型 微调整模型Ⅰ 完全调整模型Ⅱ OR 95%CI P值 OR 95%CI P值 OR 95%CI P值 ABO血型 A型 参考值 B型 1.75 0.69～4.40 0.238 1.84 0.73～4.68 0.198 1.83 0.71～4.73 0.214 O型 2.86 1.22～6.66 0.015 3.45 1.42～8.33 0.006 3.46 1.35～8.83 0.009 AB型 2.86 0.47～17.61 0.257 2.81 0.49～16.12 0.246 2.83 0.52～15.34 0.227 Tac血药浓度 低浓度 参考值 中浓度 3.08 1.23～7.73 0.017 3.45 1.39～8.56 0.007 3.51 1.36～9.06 0.010 高浓度 5.34 1.44～19.82 0.012 4.99 1.35～18.48 0.016 4.82 1.22～19.00 0.045 术前球蛋白 0.92 0.87～0.99 0.018 0.94 0.88～1.01 0.101 0.94 0.87～1.01 0.089
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