肾移植后高尿酸血症对移植肾远期功能的影响

Influence of post-transplantation hyperuricemia on the late function of renal allografts

目的探讨肾移植术前后高尿酸血症的患病率及高尿酸血症对移植肾远期功能的影响。方法比较216例肾移植受者肾移植术前48h和术后1个月内高尿酸血症的患病率。按术前48h及术后1个月内有无高血尿酸血症将受者分为A、B、C、D组(A组术前及术后血尿酸水平均正常;B组术前血尿酸水平增高,术后正常;C组术前血尿酸水平正常,术后增高;D组术前及术后血尿酸水平均增高),另按术后1个月内的血尿酸水平(正常,高于正常但<500μmol/L,>500μmol/L)将受者分为A′、B′、C′组,比较以上各组术后12、24、36个月的血肌酐水平。结果术前男性受者高尿酸血症患病率为34.2%,女性为37.1%;术后男性患病率为36.3%,女性为42.9%,与术前相比均无显著性差异(P>0.05)。女性术后高尿酸血症患病率高于男性(P<0.05)。男女受者术后平均血尿酸水平均高于术前(P<0.01)。术后12、24和36个月,C、D组血肌酐水平显著高于A、B组(P<0.05,P<0.01),而A、B组间比较及C、D组间比较无显著性差异(P>0.05)。C′组血肌酐水平显著高于其他两组(P<0.05),B′组显著高于A′组(P<0.05)。结论肾移植术后肾功能恢复良好的受者,其术后血尿酸水平均高于术前,且以女性显著。肾移植后高尿酸血症可能是导致慢性移植肾失功的因素之一。

Objective To investigate the prevalence of hyperuricemia in recipients undergone kidney transplantation due to end-stage renal disease （ESRD）, and the effects of hyperurieemia on the late function of renal allografts. Methods The prevalence of hyperuricemia of 216 recipients 48 hour pre- and within 1 month after kidney transplantation was compared. All the recipients were assigned to group A, B, C and D according to the occurrence of hyperuricemia 48-hour before and within one month after kidney transplantation. Furthermore, the recipients were stratified into groups A＇, B＇ and C＇ according to blood uric acid levels （normal, higher than normal but lower than 500μmol/L, higher than 500μmol/L） within one month after kidney transplantation. Serum creatinine levels at 12, 24 and 36 months after transplantation of aforesaid groups were measured and compared. Results The prevalence of hyperuricemia was 34. 2% in males and 37. 7% in females 48 hours before transplantation, while it was 36.3% in males and 42. 9% in females after transplantation, therefore there was no significant difference between pre- and post transplantation （P〉0. 05）. But its incidence was higher in females than in males after transplantation （P〈0. 05）, although both male and female recipients exhibited higher uric acid levels after kidney transplantation （P〈0. 01）. During the course of follow-up at 12, 24 and 36 months, the serum ereatinine levels were higher in group C and D （P〈0. 05 and P〈0. 01）, the valus of group B was similar to that of group A, and no significant difference existed between group C and D. The serum creatinine level was higher in group C than in group A; and 13 （P〈0. 05）, and higher in group B than in group A （P〈0. 05） during follow-up. Conclusions The blood uric acid levels were higher in recipients, especially in females, although rehabilitation is satisfactory after transplantation. The hyperuricimia may be one of the factors precipitating chronic failure of renal allografts.