摘要
目的 探讨移植肾丢失后维持性血液透析患者的治疗策略.方法 选择2013年5月在山西省第二人民医院肾移植透析中心接受维持性血液透析治疗的26例慢性移植肾丢失患者作为移植组,选择同期年龄、性别及透析维持时间相匹配的26例普通透析患者作为对照组.两组患者原发病均以不明原因的慢性肾小球肾炎为主.记录移植组患者移植肾状况,记录两组患者维持性血液透析的治疗情况.两组间计量资料比较采用t检验,率的比较采用x2检验或Fisher精切概率法.结果 移植组再次进入维持性血液透析的中位时间为39个月（1～186个月）,对照组维持性血液透析的中位时间为37个月（1 ～192个月）.移植组患者留存1个移植肾者20例,留存2个移植肾者2例,完全移植肾切除4例.留存移植肾的22例患者中,6例完全停用免疫抑制剂,16例维持小剂量免疫抑制剂.移植组患者再次进入维持性血液透析前,主要表现为不同程度的蛋白尿和/或“爬行肌酐”、重度水肿,血浆白蛋白平均值为（34 ±6） g/L,与对照组比较低蛋白血症程度更严重（t=-2.420,P ＜0.05）;平均血清肌酐（654±272） μmol/L,低于对照组（t=-3.979,P＜0.05）;用MDRD公式计算的肾小球滤过率（GFR）低于对照组（t=2.656,P ＜0.05）,但用血清胱抑素C计算的GFR两组差异无统计学意义（t=1.395,P＞0.05）.至2013年5月,移植组和对照组患者体质量指数分别为（20.1±2.3）kg/m2和（22.6±4.2）kg/m2,血浆白蛋白分别为（41 ±6） g/L和（45 ±4） g/L,两组比较差异均有统计学意义（t=-2.645和-2.512,P均＜0.05）.与对照组比较,移植组血红蛋白水平较低,促红细胞生成素（EPO）用量和EPO抵抗指数（ERI）较高.移植组和对照组血红蛋白分别为（100±17） g/L和（115 ±18） g/L,血红蛋白达标的患者分别为9例和17例,两组差异均有统计学意义（t=-3.028,x2=4.923,P均＜0.05）;平均每周EPO用量�
Objective To improve the quality of life in patients after renal allograft loss on maintenance hemodialysis.Methods A cross-sectional study was performed that 26 patients after chronic renal allograft loss on maintenance hemodialysis as transplantation group and 26 patients matched with gender,age and maintained hemodialysis vintage as control group in May2013.The main primary disease was chronic primary glomerulonephritis in two groups.The renal allograft situation was recorded and the parameters related to hemodialysis treatment were analyzed.The t test and Chi-square test or Fisher＇s exact test was used for statistics.Results The median maintenance hemodialysis time was 39 months （1-186） in the transplantation group and 37 months （1-192） in the control group.There were 20 recipients with one renal graft and 2 recipients with two renal grafts.Complete graft nephrectomy was done in 4 patients.Six patients discontinued immunosuppressant completely while 16 recipients maintained low-dose immunosuppressant therapy.The clinical manifestations were proteinuria,crawling creatinine and severe edema in recipients before returned to hemodialysis.The mean plasma albumin was （34 ± 6） g/L in the transplantation group which was lower than that in the control group （39 ±6） g/L,and the difference was of statistical significance （t =-2.420,P 〈0.05）.The serum creatinine was （654 ±272） μmol/L in transplantation group and it was lower than that in the control group （1 077 ± 414） μmol/L,and the difference was of statistical significance （t =-3.979,P 〈 0.05）.The eGFR in accordance with the MDRD formula in transplantation group was higher than the control group （t =2.656,P 〈 0.05）,but the eGFR calculated by Cystatin-C method was similar in two groups （t=1.395,P〉0.05）.InMay2013,BMIwas （20.1 ±2.3） kg/m2and （22.6±4.2） kg/m2,and plasma albumin was （41 ±6） g/L and （45 ±4） g/L in the transplantation group and the control group,respectively （t =-2.645,t =-2.512,P
出处
《中华移植杂志（电子版）》
CAS
2014年第3期21-28,共8页
Chinese Journal of Transplantation(Electronic Edition)
