摘要
目的探讨尿毒症患者肾移植术后发生移植肾动脉狭窄(TRAS)的相关危险因素。方法本研究为回顾性病例对照研究。回顾性分析2018年6月至2022年6月河北医科大学第二医院收治的220例行肾移植术的尿毒症患者的临床资料。根据随访期间TRAS发生情况分为TRAS组和无TRAS组。比较两组患者的基线资料,采用二元Logistic回归分析肾移植术后TRAS的危险因素和保护因素。采用受试者工作特征(ROC)曲线分析相关危险因素对TRAS发生预测价值。绘制导致TRAS的危险因素的决策曲线。结果220例患者均随访满1年,肾移植术后24例患者出现TRAS,发生率为10.91%(24/220),术后至TRAS发生时间间隔为(6.68±1.05)个月。TRAS组发生急性排斥反应、高脂血症及高尿酸血症患者占比高于无TRAS组(20.83%比2.55%,χ^(2)=12.527,P<0.001;45.83%比18.88%,χ^(2)=7.596,P=0.006;29.17%比9.18%,χ^(2)=6.061,P=0.014),且TRAS组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇及尿酸水平高于无TRAS组[(7.18±2.05)mmol/L比(5.68±1.26)mmol/L,t=5.081,P<0.001;(3.63±1.74)mmol/L比(2.05±1.06)mmol/L,t=6.348,P<0.001;(4.82±1.33)mmol/L比(3.63±0.98)mmol/L,t=5.381,P<0.001;(417.34±24.03)μmol/L比(394.28±18.85)μmol/L,t=5.479,P<0.001],高密度脂蛋白胆固醇(HDL-C)低于无TRAS组[(1.03±0.46)mmol/L比(1.49+0.42)mmol/L,t=5.012,P<0.001],差异均有统计学意义。二元Logistic回归分析结果显示,急性排斥反应、TC、TC及血清尿酸水平升高是尿毒症患者肾移植术后发生TRAS的独立危险因素(均OR>1,P<0.05);HDL-C水平升高是尿毒症患者肾移植术后发生TRAS的保护因素(OR<1,P<0.05)。ROC曲线结果显示,TC、TG、HDL-C、血清尿酸水平及联合检测预测尿毒症患者肾移植术后发生TRAS的曲线下的面积均>0.700,且联合检测最高,为0.929。绘制决策曲线结果显示,血清尿酸水平与血脂水平单独及联合评估尿毒症患者肾移植术后发生TRAS的净收益率均>0,且联合预测的净收益率最高。结论尿毒症患者肾移植术后发生TRAS与尿酸水平、血脂水平升高关系密切。
Objective To explore the related risk factors of transplant renal artery stenosis(TRAS)among patients with uremia after renal transplantation.Methods This was a retrospective case-control study.The clinical data of 220 patients with uremia who underwent kidney transplantation admitted to the Second Hospital of Hebei Medical University from June 2018 to June 2022 were retrospectively analyzed.According to the occurrence of TRAS during the follow-up period,the patients were divided into TRAS group and non-TRAS group and the baseline data of the two groups were compared.Binary logistic regression was used to analyze the risk factors and protective factors of TRAS after renal transplantation.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of risk factors for TRAS.Decision curve of risk factors leading to TRAS was made.Results After one-year follow-up,TRAS was observed in 24 patients after renal transplantation with an incidence of 10.91%(24/220),and the time from surgery to the occurrence of TRAS was(6.68±1.05)months.The proportion of patients with acute rejection,hyperlipidemia,and hyperuricemia in the TRAS group was higher than that in the non-TRAS group(20.83%vs.2.55%,χ^(2)=12.527,P<0.001;45.83%vs.18.88%,χ^(2)=7.596,P=0.006;29.17%vs.9.18%,χ^(2)=6.061,P=0.014).Moreover,the total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol,and serum uric acid levels of patients in the TRAS group were higher than those of the non-TRAS group[(7.18±2.05)mmol/L vs.(5.68±1.26)mmol/L,t=5.081,P<0.001;(3.63±1.74)mmol/Lvs.(2.05±1.06)mmol/L,t=6.348,P<0.001;(4.82±1.33)mmol/Lvs.(3.63±0.98)mmol/L,t=5.381,P<0.001;(417.34±24.03)μmol/Lvs.(394.28±18.85)μmol/L,t=5.479,P<0.001],and high-density lipoprotein cholesterol(HDL-C)was lower than that of the non-TRAS group[(1.03±0.46)mmol/L vs.(1.49±0.42)mmol/L,t=5.012,P<0.001],the differences were all statistically significant.The results of binary Logistic regression analysis showed that acute rejection,elevated levels of TC,TG and serum uric acid were independent risk factors for the occurrence of TRAS in patients with uremia after renal transplantation(all OR>1,P<0.05),and high HDL-C expression was a protective factor for the occurrence of TRAS after renal transplantation in patients with uremia(OR<1,P<0.05).The results of ROC curve demonstrated that the area under the curve of TC,TG,HDL-C,serum uric acid levels and combined detection to predict the occurrence of TRAS in patients with uremia after renal transplantation were all>0.700,and the combined detection had the highest value(0.929)among them.The decision curve results illustrated that the serum uric acid level and blood lipid level,when evaluated separately or in combination,had a net benefit rate greater than O in predicting the occurrence of TRAS after kidney transplantation in patients with uremia.The highest net benefit rate was achieved when they were combined.Conclusion The occurrence of TRAS in patients with uremia after kidney transplantation is closely related to elevated levels of uric acid and blood lipids.
作者
王鉴
崔南奇
池魁
孙欢欢
袁涛
侯佳豪
毕伟
Wang Jian;Cui Nanqi;Chi Kui;Sun Huanhuan;Yuan Tao;Hou Jiahao;Bi Wei(Department of Vascular Surgery,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《中华血管外科杂志》
2024年第1期37-43,共7页
Chinese Journal of Vascular Surgery
关键词
移植肾动脉狭窄
尿酸
血脂
急性排斥反应
危险因素
Transplanted renal artery stenosis
Uric acid
Blood lipids
Acute rejection reaction
Risk factor
