期刊文献+

肝移植术后慢性肾功能损伤的危险因素分析 被引量:4

Risk factors for chronic renal dysfunction after liver transplantation
原文传递
导出
摘要 目的探讨影响肝移植术后慢性肾功能损伤(CRD)的危险因素。方法回顾性分析2007年1月至2008年1月于中国人民武装警察部队总医院接受肝移植术后生存时间〉3年的101例患者的临床资料,应用MDRD公式计算术前以及术后1、3年的肾小球滤过率(GFR)。根据术后GFR是否〈60ml/min将患者分为CRD组(16例)和对照组(85例)。采用,检验或t检验对可能影响肝移植术后肾功能的16项危险因素(性别、年龄、高血压、糖尿病、肌酐、尿素氮、他克莫司浓度、术前GFR、热缺血时间、冷缺血时问、国际标准化比值、TP、TBil、Au、AST、ALP)进行单因素分析,将差异有统计学意义的因素进行Logistic多因素回归分析。结果101例肝移植患者手术前GFR为(103±22)ml/min,其中3例患者术前GFR〈60ml/min;101例患者肝移植术后1、3年GFR分别为(91±22)ml/rain和(834-21)ml/min,其中7例患者肝移植术后1年GFR〈60ml/min,16例患者术后3年GFR〈60ml/min。单因素分析结果表明:高血压、糖尿病、肌酐、尿素氮、他克莫司浓度和术前GFR是肝移植术后CRD的危险因素(x2=9.400,21.917,t=51.024,91.620,41.381,99.000,P〈0.05)。多因素分析结果表明:高血压、糖尿病和术前GFR是肝移植术后CRD的独立危险因素(OR=65.438,17.903,0.911,P〈0.05)。结论GFR降低和手术前合并高血糖和高血压是肝移植术后CRD的危险因素。 Objective To investigate the risk factors for chronic renal dysfunction (CRD) after liver transplantation. Methods The clinical data of 101 patients who survived more than 3 years after liver transplanta- tion at the General Hospital of Armed Police Forces fl'om January 2007 to January 2008 were retrospectively ana- lyzed. The glomeruar filtration rate (GFR) before operation and at postoperative year 1 and 3 were calculated by the modification of diet in renal disease (MDRD) formula. All the patients were divided into the CRD group (16 patients) and the control group (85 patients) according to whether the GFR was under 60 ml/min. Risk factors (gender, age, diabetes mellitus, creatinine, urea nitrogen, tacrolimus level, preoperative GFR, warm ischemia time, cold ischemia time, international normalized ratio, total protein, total bilirubin, alanine transaminase, aspartate transaminase, alkaline phosphatase ) for CRD after liver transplantation were analyzed using chi-square test or t test, and multivariate analysis was done using Logistic regression models. Results The mean preoperative level of GFR of the 101 patients was (103 _+ 22)ml/min, and the preoperative levels of GFR of 3 patients were under 60 ml/min. The mean levels of GFR of the 101 patients at postoperative year 1 and 3 were (91 +_22) mL/min and (83 -+ 21 )ml/min, and the levels of GFR at postoperative year 1 of 7 patients were under 60 ml/min, and the levels of GFR at postoperative year 3 of 16 patients were under 60 ml/min. The results of univariate analysis showed that hypertension, diabetes mellitus, creatinine, blood urea nitrogen, tacrolimus level and preoperative GFR were risk factors for CRD after liver transplantation 0(2=9. 400, 21. 917, t =51. 024, 91. 620, 41. 381, 99. 000, P 〈 0.05). The results of multivariate analysis showed that hypertension, diabetes mellitus and preoperative GFR were independent risk factors for CRD after liver transplantation ( OR = 65. 438, 17. 903, 0. 911, P 〈 0
出处 《中华消化外科杂志》 CAS CSCD 北大核心 2013年第9期688-691,共4页 Chinese Journal of Digestive Surgery
基金 中国博士后科学基金面上资助项目(20090461497)
关键词 肝移植 慢性肾功能损伤 危险因素 Liver transplantation Chronic renal dysfunction Risk factors
  • 相关文献

参考文献16

  • 1Weber ML, Lbrahim HN, Lake JR, et al. Renal dysfunction in liver transplant recipients: evaluation of the critical issues. Liver Transp1,2012,18 ( 11 ) : 1290-1301. 被引量:1
  • 2阚彤,杨甲梅,严以群,吴孟超.前列腺素E1对大鼠肝移植肾功能的保护作用[J].中华消化外科杂志,2007,6(5):366-368. 被引量:3
  • 3刘现忠,王轩,张斌,李增才,江涛,陆雷,王兵济,张冬华,张荣生.慢性肾功能损伤的肝移植受者转换为西罗莫司治疗的疗效观察[J].中华器官移植杂志,2011,32(11):668-671. 被引量:3
  • 4Sharma P, Welch K, Eikstadt R, et al. Renal outcomes after liver transplantation in the model for end-stage liver disease era. Liver Transp1,2009,15 (9) : 1142-1148. 被引量:1
  • 5AI Riyami D, Alam A, Badovinac K, et al. Decreased survival in liver transplant patients requiring chronic dialysis: a Canadian experience. Transplantation, 2008,85 ( 9 ) : 1277-1280. 被引量:1
  • 6Garces G, Contreras G, Carvalho D, et al. Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacroli- mus. Clinical Nephrology,2011,75(2) : 150-157. 被引量:1
  • 7Schmitz V, Laudi S, Moeckel F, et al. Chronic renal dysfunction following liver transplantation. Clin Transplant,2008,22(3) :333-340. 被引量:1
  • 8Baid S, Cosimi AB, Farrell ML, et al. Posttransplant diabetes mellitus in liver transplant recipients: risk factor, temporal rela- tionship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation,2001,72(6) :1066-1072. 被引量:1
  • 9Kubal C, Cockwell P, Gunson B, et al. Chronic kidney disease after nonrenal solid organ transplantation: a histological assessmentand utility of chronic allografi damage index scoring. Transplanta- tion,2012,93 (4) :406-411. 被引量:1
  • 10Calmus Y, Conti F, Cluzel P, et al. Prospective assessment of renal histopathological lesions in patients with end-stage liver dis- ease : effects on long-term renal function after liver transplantation. J I-Iepato1,2012,57 ( 3 ) :572-576. 被引量:1

二级参考文献45

  • 1王轩,吴幼民,许正昌,张斌,李增才,陆雷,郑以山.雷帕霉素在合并急性肾功能不全肝移植患者中的初步应用[J].世界华人消化杂志,2006,14(30):2974-2976. 被引量:2
  • 2叶任高,陆在英.内科学.第6版.北京:人民卫生出版社,2005:95-96. 被引量:55
  • 3Falkenhain ME, Cosio FG, Sedmak DD. Progressive histologic injury in kidneys from heart and liver transplant recipients receiving cyclosporine. Transplantation, 1996, 62(3) :364-370. 被引量:1
  • 4Wilkinson A, Pham PT. Kidney dysfunction in the recipients of liver transplants. Liver Transpl, 2005,11 Suppl 2:S47-51. 被引量:1
  • 5Ramachandran J, Juneja R, John L, et al. Chronic kidney disease following liver transplantation: a South Australian experience. Transplant Proc, 2010, 42(9):3644-3646. 被引量:1
  • 6Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol, 2009, 4(2):481-508. 被引量:1
  • 7Hornberger TA, Sukhija KB, Wang XR, et al. mTOR is the rapamycin-sensitive kinase that confers mechanically-induced phosphorylation of the hydrophobic motif site Thr(389) in p70 (S6k). FEBS Letters, 2007, 581(24) :4562-4566. 被引量:1
  • 8Li BG, Hasselgren PO, Fang CH. Insulin-like growth factorI inhibits dexamethasone induced proteolysis in cultured 1.6 myotubes through PI3K/Akt/GSK-3beta and PDK/Akt/ mTOR dependent mechanisms. Int J Biochem Cell Biol, 2005, 37(10) :2207-2216. 被引量:1
  • 9Hong JC, Kahan BD. Sirolimus reBcue therapy for refractory rejection in renal transplantation. Transplantation, 2001, 71 (11):1579-1584. 被引量:1
  • 10Oliveria JG, Xavier P, Sampaio SM, et al. Compared to myeophenolate mofetil, rapamyein induces significant changes on growth factors and growth factor receptors in the early days post-kidney transplantation. Transplantation, 2002, 73 (6) : 915-920. 被引量:1

共引文献8

同被引文献55

引证文献4

二级引证文献8

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部