肾移植患者术后股骨头坏死临床研究

Clinical study on avuscular necrosis of femoral head after renal transplantation

目的探讨肾移植术后股骨头坏死的发病情况及相关因素。方法对572例接受肾移植的患者进行普查,观察患者术前的透析时间、糖皮质激素量(静脉及口服)及时间、股骨头坏死发病时间。结果415名患者得到随诊,共发现4例股骨头坏死患者,皆为双侧,患病率为0.98%,平均发病时间为6.25个月,患者术后前3d静脉甲基强的松龙的平均用量是(2841.47±967.92)mg,第1年(2990.60±1078.45)mg,第1个月口服强的松的平均剂量是(763.10±125.76)mg,第1年为(4831.27±693.88)mg。结论肾移植术后股骨头坏死的患病率低,主要原因是激素在抗免疫治疗中的比重降低,冲击治疗时间短,降血脂及时。患病原因和糖皮质激素及个体对糖皮质激素的敏感度差异有关。

[Objective] To analyze the prevalance and risk factors of avuscular necrosis of femoralhead（ANFH） after renal transplantation. [Methods] Investagated 572 renal transplantation recipients, observed the dialysis duration pre-transplant,dose and duration of corticoid,time from transplantation to onset of joint pain. [Results] 412 patients were followed up, 4 （0.98%） were found to be ANFH, all suffered both femoral head, mean duration of ocurrence is 6.25 months, the mean dose of methylprednisolone for 3 days post-operation is （2841.47±967.92） mg, and （2990.60±1078.45） mg for first year,the mean dose of prednisone for first month is （763.10±125.76） mg, and （4831.27±693.88） mg for first year. [Conclusion] This study showed low prevalence of ANFH after renal transplantation, the major reason is low proportion of corticoid, short time of large dose corticoid therpy, control of lipemia. Corticoid and idiosyncrasy to the corticoid in individual bases may related to ANFH.