肾移植受者术前合并代谢综合征对早期移植肾功能的影响

唐永斌; 田子健; 张志鹏; 王劲夫; 刘明; 张亚群

doi:10.3969/j.issn.1674-7445.2024045

肾移植受者术前合并代谢综合征对早期移植肾功能的影响

doi: 10.3969/j.issn.1674-7445.2024045

唐永斌^{1, 2,},
田子健³,
张志鹏¹,
王劲夫¹,
刘明^{1, 2},
张亚群^3, ,

1.
100730　北京，北京医院泌尿外科国家老年医学中心中国医学科学院老年医学研究院
2.
中国医学科学院北京协和医学院研究生院
3.
天津医科大学第二医院泌尿外科天津市泌尿外科研究所

基金项目: 中央高水平医院临床科研业务费（BJ-2022-174）

详细信息

作者简介:

通讯作者:
张亚群（ORCID 0000-0002-5332-6675），博士，主任医师，研究方向为肾移植，Email：zhangyqbjyy@126.com

中图分类号: R617, R589
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出版历程
- 收稿日期: 2024-02-18
- 网络出版日期: 2024-04-28
- 刊出日期: 2024-07-15

Effect of preoperative metabolic syndrome on early function of renal allografts in kidney transplant recipients

Tang Yongbin^{1, 2
,},
Tian Zijian³,
Zhang Zhipeng¹,
Wang Jinfu¹,
Liu Ming^{1, 2},
Zhang Yaqun^{3
, ,}

1.
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China

More Information

Corresponding author: Zhang Yaqun, Email: zhangyqbjyy@126.com

摘要

摘要: 目的探讨同种异体肾移植受者术前合并代谢综合征对早期移植肾功能的影响。方法回顾性分析117例肾移植受者的临床资料，根据移植肾功能分为移植物功能延迟恢复（DGF）组（29例）和非DGF组（88例），应用单因素和多因素回归分析同种异体肾移植受者发生DGF的相关危险因素，分析肾移植受者术前合并代谢综合征对早移植肾功能的影响。结果 117例肾移植受者，47例术前合并代谢综合征，29例术后发生DGF，DGF组中83%术前合并代谢综合征，高于非DGF组中的74%（P<0.05）。单因素分析结果显示，DGF组供者体质量指数（BMI）、终末血清肌酐（Scr），受者术前BMI、血糖、甘油三酯水平、术前合并代谢综合征比例均高于非DGF组（均为P<0.05）。多因素logistic回归分析结果显示，供者Scr水平高、受者术前血红蛋白水平高、受者术前合并代谢综合征是肾移植术后发生DGF的独立危险因素（均为P<0.05）。结论受者术前合并代谢综合征是同种异体肾移植发生DGF的独立危险因素，应采取相关策略以减少DGF和其他与代谢相关的并发症的发生率。
- 肾移植 /
- 代谢综合征 /
- 肥胖 /
- 血糖 /
- 血脂 /
- 移植物功能延迟恢复 /
- 血清肌酐 /
- 估算肾小球滤过率
Abstract: Objective To evaluate the effect of preoperative metabolic syndrome on early function of renal allografts in allogeneic kidney transplant recipients. Methods Clinical data of 117 kidney transplant recipients were retrospectively analyzed. According to the renal allograft function, they were divided into the delayed graft function (DGF) group (n=29) and non-DGF group (n=88). Relevant risk factors of DGF in recipients undergoing allogeneic kidney transplantation were assessed by univariate and multivariate regression analyses. The effect of preoperative metabolic syndrome on early function of renal allografts was analyzed. Results Among 117 kidney transplant recipients, 47 cases were complicated with preoperative metabolic syndrome, and 29 cases developed postoperative DGF. In the DGF group, 83% of the recipients were complicated with preoperative metabolic syndrome, higher than 74% in the non-DGF group (P<0.05). Univariate analysis showed that the body mass index (BMI) and terminal serum creatinine (Scr) level of the donors, and BMI, blood glucose level, triglyceride level and the proportion of preoperative metabolic syndrome of the recipients in the DGF group were higher than those in the non-DGF group (all P<0.05). Multivariate logistic regression analysis revealed that high Scr levels of the donors, high hemoglobin levels of the recipients and preoperative metabolic syndrome of the recipients were the independent risk factors for DGF after kidney transplantation (all P<0.05). Conclusions Preoperative metabolic syndrome is an independent risk factor for DGF in allogeneic kidney transplant recipients. Corresponding measures should be taken to lower the incidence of DGF and other metabolic complications.
- Kidney transplantation /
- Metabolic syndrome /
- Obesity /
- Blood glucose /
- Blood lipid /
- Delayed graft function /
- Serum creatinine /
- Estimated glomerular filtration rate

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FIG. 3258. FIG. 3258.

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表 1 术前合并与不合并代谢综合征受者及其相应供者的一般情况比较

Table 1. Comparison of the general situation of recipients with and without preoperative metabolic syndrome and their corresponding donors

变量	合并代谢综合征（n=47）	不合并代谢综合征（n=70）	统计值	P值
供者资料
年龄（$\overline x \pm s $，岁）	52±10	46±11	2.788	0.006
性别[n（%）]			0.890	0.345
男	43（91）	60（86）
女	4（9）	10（14）
BMI（$\overline x \pm s $，kg/m²）	24.7±3.1	23.6±3.6	1.722	0.088
终末Scr[M（P₂₅,P₇₅），μmol/L]	74（52，112）	51（35，68）	3.375	<0.001
受者资料
年龄（$\overline x \pm s $，岁）	48±11	48±12	0.050	0.480
性别[n（%）]			0.143	0.705
男	37（79）	53（76）
女	10（21）	17（24）
术前BMI（$\overline x \pm s $，kg/m²）	25.6±2.6	22.8±2.6	5.656	<0.001
术前收缩压（$\overline x \pm s $，mmHg）	143±18	144±16	0.380	0.352
术前舒张压（$\overline x \pm s $，mmHg）	82±11	85±11	1.719	0.088
术前血红蛋白（$\overline x \pm s $，g/L）	108±16	111±20	0.635	0.527
术前白蛋白（$\overline x \pm s $，g/L）	41±6	43±5	1.960	0.052
术前血糖（$\overline x \pm s $，mmol/L）	7.2±2.5	5.3±1.4	4.736	<0.001
术前Scr（$\overline x \pm s $，μmol/L）	919±248	858±292	1.183	0.239
术前尿酸[M（P₂₅,P₇₅），μmol/L）	384（298，444）	356（274，421）	1.318	0.188
术前甘油三酯[M（P₂₅,P₇₅），mmol/L]	2.3（1.8，3.8）	1.3（1.0，1.6）	6.419	<0.001
术前高密度脂蛋白[M（P₂₅,P₇₅），mmol/L]	0.8（0.7，1.0）	1.2（1.1，1.4）	6.300	<0.001
术前透析方式[n（%）]			0.760	0.766
未透析	7（15）	7（10）
血液透析	32（68）	49（70）
腹膜透析	8（17）	14（20）
术前透析时间[M（P₂₅,P₇₅），月]	11（4，24）	11（3，24）	0.234	0.815
肾动脉吻合方式[n（%）]				0.515
髂外动脉	47（100）	68（97）
髂内动脉	0	2（3）
冷缺血时间[M（P₂₅,P₇₅），h]	6（5，9）	6（5，8）	0.862	0.388

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表 2 肾移植术后发生DGF危险因素的单因素分析

Table 2. Univariate analysis of risk factors for DGF after kidney transplantation

变量	DGF组（n=29）	非DGF组（n=88）	统计值	P值
供者资料
年龄（$\overline x \pm s $，岁）	51±12	48±11	1.531	0.128
性别[n（%）]				0.184
男	28（97）	75（85）
女	1（3）	13（15）
BMI（$\overline x \pm s $，kg/m²）	25.3±2.1	23.6±3.7	2.430	0.017
终末Scr[M（P₂₅,P₇₅），μmol/L]	98（75，166）	50（36，66）	6.093	<0.001
受者资料
年龄（$\overline x \pm s $，岁）	46±10	49±11	1.394	0.166
性别[n（%）]			2.826	0.093
男	19（66）	71（81）
女	10（34）	17（19）
术前BMI（$\overline x \pm s $，kg/m²）	25.0±3.0	23.6±2.8	2.397	0.018
术前收缩压（$\overline x \pm s $，mmHg）	139±15	145±17	1.480	0.142
术前舒张压（$\overline x \pm s $，mmHg）	82±11	84±11	1.144	0.255
术前血红蛋白（$\overline x \pm s $，g/L）	115±16	108±19	1.848	0.067
术前白蛋白（$\overline x \pm s $，g/L）	41±7	42±5	0.765	0.449
术前血糖（$\overline x \pm s $，mmol/L）	7.2±2.7	5.6±1.8	2.836	<0.001
术前Scr[M（P₂₅,P₇₅），μmol/L]	888±287	881±274	0.130	0.897
术前尿酸[M（P₂₅,P₇₅），μmol/L]	383（298，436）	378（282，435）	0.341	0.733
术前甘油三酯[M（P₂₅,P₇₅），mmol/L]	2.3（1.5，3.6）	1.4（1.2，1.8）	3.213	0.001
术前高密度脂蛋白[M（P₂₅,P₇₅），mmol/L]	1.0（0.7，1.3）	1.1（0.9，1.3）	1.708	0.088
术前透析方式[n（%）]				0.035
未透析	4（14）	10（11）
血液透析	24（83）	57（65）
腹膜透析	1（3）	21（24）
术前透析时间[M（P₂₅,P₇₅），月]	12（5，24）	11（3，24）	0.468	0.640
肾动脉吻合方式[n（%）]				1.000
髂外动脉	29（100）	86（98）
髂内动脉	0	2（2）
冷缺血时间[M（P₂₅,P₇₅），h]	6（5，9）	6（5，8）	0.629	0.529
术前合并代谢综合征[n（%）]			29.097	<0.001
是	24（83）	65（74）
否	5（17）	23（26）

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表 3 肾移植术后发生DGF危险因素的多因素分析

Table 3. Multivariate analysis of risk factors for DGF after kidney transplantation

变量	回归系数	标准误	Wald χ²	比值比	95%可信区间	P值
供者终末Scr	0.014	0.005	7.107	1.014	1.004～1.024	0.008
受者术前血红蛋白	0.042	0.018	5.192	1.043	1.006～1.081	0.023
受者术前合并代谢综合征	2.836	0.672	17.794	17.048	4.565～63.670	<0.001

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表 4 2组受者术后早期移植肾功能比较

Table 4. Comparison of renal graft function of recipients in the early postoperative period between 2 groups [M（P₂₅,P₇₅）]

变量	合并代谢综合征（n=47）	不合并代谢综合征（n=70）	检验值	P值
Scr（μmol/L）
术后1 d	683（497，878）	550（414，669）	2.824	0.005
术后2 d	433（262，838）^a	282（199，392）^a	3.761	<0.001
术后3 d	287（165，651）^a,b	174（127，271）^a,b	3.953	<0.001
eGFR[mL/（min·1.73 m²）]
术后1 d	6.66（5.00，9.78）	8.61（6.20，12.13）	2.924	0.003
术后2 d	11.40（5.61，22.58）^a	19.96（12.67，31.43）^a	3.725	<0.001
术后3 d	18.88（7.73，37.48）^a,b	34.81（20.69，53.47）^a,b	3.947	<0.001
注：与术后1 d比较，^aP<0.05/3；与术后2 d比较，^bP<0.05/3。

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