摘要
目的分析肾移植术后红细胞增多症(PTE)的临床特征、高危因素、治疗及转归。方法分析2008年1月-2012年1月解放军309医院泌尿外科肾移植术后的受者329例。65例发生红细胞增多症(PTE组),264例未发生红细胞增多症(对照组)。比较PTE组与对照组的临床特征,术前、术后各项指标,不同治疗方案的效果及预后。结果PTE组患者较对照组患者年轻,男性患者比例高(P<0.05);PTE组体重指数(BMI)、血甘油三酯、总蛋白、白蛋白水平较对照组明显升高,差异有统计学意义(P<0.05);吸烟、移植肾功能良好且急性排斥反应发生率低、伴高血压及糖尿病的受者更易发生PTE(P<0.05)。血促红细胞生成素含量在两组间差异无统计学意义(P>0.05)。应用环孢素的受者(n=185)PTE发病率(24.3%)高于应用他克莫司的受者(n=144,13.9%),差异有统计学意义(P<0.05)。PTE组患者根据治疗方案不同分为保守观察(n=41)和静脉放血治疗(n=24),保守观察有效率78.0%(32/41),静脉放血治疗有效率75.0%(18/24),两者无统计学差异(P>0.05),但保守观察患者的PTE复发率及并发血栓栓塞率较静脉放血治疗低,差异有统计学意义(P<0.05)。结论肾移植术后红细胞增多症以男性及移植肾功能良好者多见,吸烟、高营养状态、伴发高血压及糖尿病是PTE发病的高危因素,应用他克莫司为基础的免疫抑制剂能降低PTE的发生率,保守观察多能自愈,且复发率、血栓栓塞率低于静脉放血治疗。
Objective To analyze the clinical characteristics, risk factors, treatment and turnover of the polycythemia after kidney transplantation. Methods The clinical data of 329 renal transplantation recipients who had undergone kidney transplantation in the Transplant Center of 309 Hospital of PLA from Jan. 2008 to Jan. 2012, were retrospectively analyzed. Posttransplant erythrocytosis （PTE） was found in 65 recipients （PTE group）, and no PTE was found in 264 recipients （control group）. The pre- and post-operative parameters, the therapeutic effect of different treatments, and outcomes were compared between PTE group and control group. Results Patients in PTE group were younger, and the ratio of males was higher compared with that of control group （P〈0.05）. BMI, blood triglycerides, total protein, albumin levels were higher in PTE group than in control group, and the differences were statistically significant （P〈0.05）. Recipients were more prone to PTE if they were smokers, with better function of transplanted kidney function and lower incidence of acute rejection, or complicated by hypertension and diabetes （P〈0.05）. The levels of blood erythropoietin （EPO） between the two groups showed no statistically significant difference （P〉0.05）. PTE incidence was higher in recipients （24.3% n=185） who had accepted cyclosporine than those recipients （13.9% n= 144） who had accepted tacrolimus, and the difference was statistically significant （P〈0.05）. Recipients in PTE group were divided into conservative treatment group （n=41） and venesection group （n=24）. The effective rate in conservative treatment group （78.0%） was not significantly different from that in venesection group （75.0%, P〉0.05）, but the relapse rate and the embolism rate due to concurrent thrombus were lower in conservative treatment group than in venesection group with statistical significance （P〈0.05）. Conclusion PTE is more common in male recipients with good graft function. Smoking, high nutritional status, concomitant hypertension and diabetes are the risk factors for PTE. Administration of tacrolimus may reduce the PTE incidence. Compared with venesection treatment, conservative treatment may be more effective in treating PTE with lower relapse rate and embolism rate due to concurrent thrombus.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2013年第12期996-999,共4页
Medical Journal of Chinese People's Liberation Army
关键词
肾移植
红细胞增多症
危险因素
红细胞生成素
免疫抑制剂
治疗
预后
kidney transplantation
polycythemia
risk factors
erythropoietin
immunosuppressive agents
therapy
prognosis
