肾移植受者远期心脑血管疾病危险因素分析

Risk Factors of Long-term Cardiovascular Diseases and Cerebrovascular Diseases in Kidney Allograft Recipients

目的探讨肾移植受者远期心脑血管疾病(CVD)的危险因素。方法采用队列研究方法对361例肾移植受者进行长期随访,随访时间点为移植后第1、6、12、24、36、48、60个月,Kaplan-Meier乘积极限法计算CVD累积发病率,COX比例风险模型进行多因素分析CVD危险因素。结果移植后1、6、12、24、36、48、60个月新发CVD累积发病率分别为3.1%、5.4%、9.9%、13.0%、18.0%、21.1%、24.1%。多因素分析结果显示,移植受者术前有CVD和糖尿病史,术后CVD发病相对危险因素(RR)分别为6.34(95%CI3.76～14.60,P=0.002)和2.19(95%CI1.32～3.97,P=0.009);移植术后糖尿病、高血压、高血脂、移植肾功能不全和蛋白尿CVD发病RR分别为2.82(95%CI1.33～7.26,P=0.002)、1.18(95%CI1.02～1.34,P=0.04)、2.04(95%CI1.26～5.17,P=0.008)、1.81(95%CI1.08～3.21,P=0.03)和1.56(95%CI1.12～3.54,P=0.05);未见移植受者性别、年龄、肥胖和移植术前高血脂与CVD发病有关。结论移植受者术前有CVD和糖尿病病史,移植术后糖尿病、高血压、高血脂、移植肾功能不全和蛋白尿是CVD发生的独立危险因素。

Objective To identify the risk factors of cardiovascular diseases and cerebrovascular diseases （CVD） events in kidney allograft recipients. Methods We followed up 361 renal transplant recipients who had undergone renal transplantation in our center from January 2000 to December 2003 and evaluated the cumulative incidences and mortalities of CVD complications at baseline and post-transplantation 1, 3, 6, 12, 24, 36, g8, and 60 months. Kaplan-Meier plot was used to assess the incidence and Cox＇s proportional hazards model to determine the risk factors for cardiovascular complications. Results The cumulative incidences of CVD were 3.1% , 5.4%, 9.9%, 13.0%, 18.0%, 21.1%, and24.1% 1, 6, 12, 36, 48, and60 months after transplantation, respectively. History of diabetes mellitus （RR 2. 19, 95% CI 1.32-3.97, P = 0. 009） and CVD （RR 6.34, 95% CI 3.76-14.60, P = 0. 002 ） as well as the post-transplantation hypertension （RR 1.18, 95% CI 1.02-1.34, P=0.04） , diabetes mellitus （RR2.82, 95% CI 1.33-7.26, P=0. 002）, hypedipidemia （RR 2.04, 95% CI 1.26-5.17, P = 0. 008） and abnormal creatinine （ 〉 200 μmol/L, RR1.81, 95% CI 1.08-3.21, P=0.03）, and proteinuria （ 〉0.3 g/d , RR 1.56, 95% CI 1.12-3.54, P = 0.05 ） were independently correlated with the development of cardiovascular events. Conclusion History of diabetes mellitus and CVD, post-transplant hypertension, diabetes mellitus, hyperlipidemia, abnormal creatinine and proteinuria are the independent risk factors of the development of CVD events.