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肾移植受者新发高甘油三酯血症的危险因素:单中心分析

徐媛, 杨波, 陈成鑫, 等. 肾移植受者新发高甘油三酯血症的危险因素:单中心分析[J]. 器官移植, 2023, 14(5): 691-699. doi: 10.3969/j.issn.1674-7445.2023055
引用本文: 徐媛, 杨波, 陈成鑫, 等. 肾移植受者新发高甘油三酯血症的危险因素:单中心分析[J]. 器官移植, 2023, 14(5): 691-699. doi: 10.3969/j.issn.1674-7445.2023055
Xu Yuan, Yang Bo, Chen Chengxin, et al. Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients: a single-center analysis[J]. ORGAN TRANSPLANTATION, 2023, 14(5): 691-699. doi: 10.3969/j.issn.1674-7445.2023055
Citation: Xu Yuan, Yang Bo, Chen Chengxin, et al. Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients: a single-center analysis[J]. ORGAN TRANSPLANTATION, 2023, 14(5): 691-699. doi: 10.3969/j.issn.1674-7445.2023055

肾移植受者新发高甘油三酯血症的危险因素:单中心分析

doi: 10.3969/j.issn.1674-7445.2023055
基金项目: 贵州省基础研究计划项目(自然科学类)(黔科合基础-ZK[2023]一般376);贵州省卫生健康委科学技术基金项目(gzwkj2023-164)
详细信息
    作者简介:
    通讯作者:

    李海洋(ORCID:0000-0003-0015-5750),博士,主任医师、教授,研究方向为终末期肝病、器官移植,Email:lihaiyang@gmc.edu.cn

  • 中图分类号: R617, Q493.5

Risk factors of new-onset hypertriglyceridemia in kidney transplant recipients: a single-center analysis

More Information
  • 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。

     

  • 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
    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 $±s,kg/m2 22±3 23±4 −1.070 0.286
    是否贵州常住人口[n(%)] 0.043 0.836
     否 10(17) 16(18)
     是 50(83) 73(82)
    透析方式[n(%)] 1.200 0.548
     血液透析 44(73) 67(75)
     腹膜透析 9(15) 16(18)
     未透析 7(12) 6(7)
    透析时间[MP25, P75),月] 12(8,45) 12(8,36) 0.410 0.659
    是否二次移植[n(%)] 1.735 0.188
     否 54(90) 85(96)
     是 6(10) 4(4)
    高血压史[n(%)] 3.015 0.083
     否 23(38) 47(53)
     是 37(62) 42(47)
    糖尿病史[n(%)] 3.706 0.054
     否 51(85) 84(94)
     是 9(15) 5(6)
    输血史[n(%)] 1.568 0.210
     否 41(68) 69(78)
     是 19(32) 20(22)
    吸烟史[n(%)] 0.739 0.390
     否 45(75) 72(81)
     是 15(25) 17(19)
    饮酒史[n(%)] 1.719 0.190
     否 47(78) 77(87)
     是 13(22) 12(13)
    ABO血型[n(%)] 6.080 0.108
     A型 24(40) 21(24)
     B型 15(25) 20(22)
     O型 19(32) 43(48)
     AB型 2(3) 5(6)
    Tac血药浓度[n(%)] 5.070 0.079
     低浓度 15(25) 10(11)
     中浓度 39(65) 66(74)
     高浓度 6(10) 13(15)
    术前白蛋白($\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 $±s,mmol/L) 4.7±1.9 4.5±1.2 0.920 0.358
    术前TG[MP25, P75),mmol/L] 1.5(0.8,1.8) 1.5(1.1,2.2) 0.420 0.677
    术前胆固醇($\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
    下载: 导出CSV

    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 χ2OR 95%CIP
    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
    下载: 导出CSV

    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
    OR95%CI POR95%CIPOR95%CIP
    ABO血型
    A型参考值
    B型1.750.69~4.40 0.2381.840.73~4.68 0.1981.830.71~4.73 0.214
    O型2.861.22~6.66 0.0153.451.42~8.33 0.0063.461.35~8.83 0.009
    AB型2.860.47~17.610.2572.810.49~16.120.2462.830.52~15.340.227
    Tac血药浓度
    低浓度参考值
    中浓度3.081.23~7.73 0.0173.451.39~8.56 0.0073.511.36~9.06 0.010
    高浓度5.341.44~19.820.0124.991.35~18.480.0164.821.22~19.000.045
    术前球蛋白0.920.87~0.99 0.0180.940.88~1.01 0.1010.940.87~1.01 0.089
    下载: 导出CSV
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  • 收稿日期:  2023-03-28
  • 录用日期:  2023-07-17
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  • 刊出日期:  2023-09-15

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