肾移植术后高脂血症的影响因素研究

Clinical Study of Influencing Factors of Hyperlipidemia after Renal Transplantation

目的:研究肾移患者植术后高脂血症的影响因素。方法:回顾分析826例肾移植患者中出现高脂血症的267例患者,调查术后时间、环孢素(CsA)全血浓度对患者移植术后血脂影响,及高血脂对患者肝、肾功能和血糖的影响。结果:肾移植术后0～3个月、4～6个月、7～12个月、1～2年高脂血症发生率分别为6.8%、7.0%、7.6%、10.9%,患者首次血脂异常时的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平与CsA全血浓度呈相关趋势。肾移植患者出现高血脂时,其血肌酐(SCr)和血糖(Glu)也明显升高,服药降低血脂后,SCr和Glu明显下降至血脂异常前水平(P<0.05),而未服用调脂药仅控制饮食的患者,首次血脂异常后3个月的Glu和SCr水平继续升高,显著高于首次血脂异常时的水平(P<0.05)。结论:CsA对肾移植患者术后血脂的影响呈一定的浓度依赖性;术后1年内是肾移植受者高血脂症高发期。高血脂可明显影响移植肾功能,同时使患者血糖升高,应密切监测血脂变化,及时降脂治疗。

Objective： To Study the influencing factors of hyperlipidemia after renal transplantation. Method：267 renal transplant recipients with hyperlipidemia were analysed to investigate the effect of the time after operation and cyclosporine whole blood concentration on plasma lipid level and the effect of hyperlipidemia on liver and renal functions and plasma glucose in renal transplantation recipients. Result： he incidence rates of hyperlipidemia in 0-3 monthes, 4-6 monthes, 7- 12 monthes and 1-2 years after operation were 6.8% , 7.0%, 7.6% and 10.9% , respectively. The recipients＇ levels of total cholesterol（TC）, triglyceride （TG） and low-density lipoprotein-cholesterol （LDL-C） presented an ascending trend while their cyclosporine whole blood concentration increased. The levels of serum creatinine （Scr） and plasma glucose in the patients with hyperlipidemia markedly increased but significantly decreased when lipid lowing drugs were administrated while those increased statistically in the patients who only received low fat diet（ P 〈 0.05 ）. Conclusion ： The effect of cy- closporine on plasma lipid in renal transplantation recipients presented its concentration-dependence. The first year after operation was the period of high incidence of hyperlipidemia which had a significant effect on the renal function and plasma glucose in renal transplant recipients. Monitoring plasma lipid and treatment with lipid lowing drug in time are very important for renal transplant recipients to prolong the survival time of renal allografts.